HomeMy WebLinkAboutDrain Layers Permit 40 Hollis Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT NO i57
2
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �� `tt® L_L15 on the
side, between
at premises owned b
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 r� �,2, Licensed Drain Layer
qIssued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: -
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
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NOTES s- f _ "r _ SOUTH WINDSOR POLLUTION CONTROL
LOCATION !=a
OWNER r
TYPE OF WORK
DATE PERMIT PIPE
INSTALLE i G.
INSPECTOR = 1,1 UacAD N BY