HomeMy WebLinkAboutDrain Layers Permit 23 High Street y TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut / -� S
List No.: _ 6 f7
DRAIN LAYER'S PERMIT NO 1901
19
Pursuant to written applicattior,� %�i hp)ermission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 2 /7 dY on the
side, between
at premises owned b pp UVn CA
J f� rd e wt l L•
whose address its
and to ay 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 ( _j' USTRIAL WASTES .( ), OR ( )
Connection will be made with 4 vL r
Permit to be issued to Z:Q r bi&c r 1 5Z
the holder of Drain Layer's License No. Permit will expire on 19
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
AYE /�4J�f
Signed
Connecti harge Paid d-d, Licensed Drain Layer
Issued by (iA
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
rbr,
I
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-V 6'
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF VORK a,,,
DATE 1,2 Z2 PERMIT d PIPE
INSTAL R
INSPECTOR DRAWN BY