HomeMy WebLinkAboutDrain Layers Permit 52 Hollis Road J F
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,s i9EPARTMENT .OF PO1.LLUTION• CONThOL :B�p No.:
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DRAIN LAYER'S PERMIT' I
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Pursuync to'w1.rittea applicatlor, pernilssion is by granted 1.to the Licensed Drain Layer named herein to perform "
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_ the aibrk indcat11
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r slde, beEty _ -
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whose addresss
and to + Lay Hoii"ae Dtaln,�. Repair ous Drain, f a11 q attt, aT_Other - 1. #
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irk for "` occupancy o 11se,
wit ymlly tlnits, nth 11 } "I PI aQtes.
Type of S1:1ewage to be eonnecte ;under' his permit a
�ANI`TAR� SEVUAGB ( ), IlVDITS ALSTI;S .(" ' , 01 )`
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_Fi.� . � � �� I i'��i � I � ,r. "" ,�. as
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Petmtt to be`issue to
the balder of-Drain Lai s Llcellrdse No Fetmlt will esjre on' 19T.,
The tutdersigned Dia�ltt aver hereby yg ',es 11 the" rms a cdnzlluoils set forth 96 the por f and the rev rae side
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thereitf App'lleant', received Town erq�it No and/or H D Pertait No.
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SP C�ALs O ITZIONS
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- �onnoctlon Charge- Pald i� :4� I .. -= yc�r:_>..
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Pernnif Nee Paid $
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AI 410VIr•D ' (Date)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION S
OWNER
TYPE OF WORK
DATE PERMIT S PIPE
INSTALLER , ol
INSPECTOR DRAWN BY r""