HomeMy WebLinkAboutDrain Layers Permit 155 High Street � ,TOWN OF St)Wrli WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER' S PERMIT
N° 625
r , 19_r"
Pursuant to written applic;;V, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 5 ft* Ut 0 or on the
3I1*Vft side, between__ 0 Ids
at premises owned by
whose address is
and to _Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( X), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with Eft WIV"
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signer!-!
Connection Charge Paid ?V" Lice ed DrA aver
�s Issued by
Tax Collector
Permit Fee: Paid $ .I
INSPECTION: Check Number:
INITIAL / o (Sig)
FINAL G (Sig)
APPROVE /y^ j (Date)
(Sig)
INSPECTOR
N
poi
2y '
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER rK
TYPE OF WORK
DATE � PERMIT PIPE f'vc
INSTALLER •;o•vo
INSPECTOR DRAWN BY v