HomeMy WebLinkAboutDrain Layers Permit 22 Hollis Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
' List No.: S"464
DRAIN LAYER'S PERMIT N? 760
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 22 &114g, lbad ( wT 3 f on the
side, between
at premises owned b
whose address is 68
and to X Lay House Drain, Repair House Drain, Lay Main, Other
for +ddMtba occupancy or use,
with 0" Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (Z), INDUSTRIAL WASTES ( ), OR
Connection will be made with
Permit to be issued to AAM Wj-=jAWffikj
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 Licensed Drain Layeit—`
Issued bylt a". Ott.
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL *41 (Sig)
FINAL tJ4 (Sig)
APPROVED''I"a (Date)
tie `
(Sig)
INSPECTOR
♦ e
n
i
I r
r
I
N
i
{
I
9-�
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION a
OWNER 9. R, a
TYPE OF WORK , .,
DATE PERMIT PIPE
INSTALLER
INSPECTOR <j' DRAWN BY