HomeMy WebLinkAboutDrain Layers Permit 57 Hillside Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut 3a O S?
List No.: _
DRAIN LAYER'S PERMIT N? 2179
19
Pursuant to written applicatior, pe mission is here granted to the Licensed Drain Layer named herein to perform
the work indicated below at -�7-2 41� on the
side, betty en
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 ( ), 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
/ v� Signed4&L
`
Connectio rge Paid LJ " (/(/ Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
L c S
Ton
i
in
i
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION S
OWNER r Q
TYPE OF WORK
DATE -;;Z?-A•J gERMITal 7 PIPE 4,
INSTALLER
INSPECTOR `' DRAWN BY