HomeMy WebLinkAboutDrain Layers Permit 69 Hollis Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.: _
South Windsor, Connecticut ;
List No.:
DRAIN LAYER' S PERMIT N� 1397
"1
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ro ` �� (. ( i `ti on the
side; between
at premises owned by h/ S {' ' '; `if1 L. kilt
whose address is
and to Lay House Drain, Repair House Drain, Lay Main Other
for �. l_ .. cy: ( (._, occupancy or use,
r
with (tC l Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( INDUSTRIAL WASTES ( ), OR ( )
i F-
Connection will be made with _i n
E
Permit to be issued toV<
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
E V
Signed
Connection Charge Paid -4y�* Licensed Drain Layer'
Issued by
Tax Collector
Permit Fee: Paid $
Check Number:
INSPECTION: _
INITIAL (Sig)
FINAL (Sig)
APPROVED �� ,'�` (Date)
(Sig)
INSPECTOR
N
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION C `
1�1t
1�1; OWNER 1iJ fv11
TYPE OF WORK
� DATE f�;. I'E PERMIT PIPE
INSTALLER N ,, c
INSPECTOR DRAWN BY