HomeMy WebLinkAboutDrain Layers Permit 19 High Tower Road �- TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER' S PERMIT N? 2368
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Av 79mild 1 ))ri Ve on the
side, between
at premises owned by Igh I �/ D y S
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 ( ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to
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
Signed
Connection Charge Paid �QU — Licensed Drain Layer
�9- Issued by
Tax Collector �I a 1�734,d p
Permit Fee: Paid $
INSPECTION: Check Number: -
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
4 •
NOTES SOUTH WINDSOR PO UT 0 CONTROL
LOCATION c1 �{
OWNER h/ L° N• S
TYPE Or WORK .ti. sPulPr G ?rya.
DATE - —S'l PERMIT d PIPE
INSTALLER
INSPECTOR DRAWN BY S• C__