HomeMy WebLinkAboutDrain Layers Permit 158 Homesead Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:South Windsor, Connecticut �L--
List.No.: _ 3
r �
DRAIN LAYER'S PERMIT - -
N. 2051
z- �'� , 19
Pursuant to written application permission is hereby granted to)the Licen/s/ed Drain Lay r named herein to perform
the work indicated below at 101 1q. �m�jrf 16 r 4 t ro xel wq t
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 ,:ld ryFamily 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 Licensed Drain Layer
Issued by a`n►'��' L
Tax Collector
ass I
Permit Fee: Paid $
INSPECTION: Check Number: ,
INITIAL (Sig �/!7 f�P� o r)
y
FINAL (Sig)
APPROVED C (Date)
- r^ (Sig)
INSPE TOR
r
N
iy
'AL' c'
J
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT Z ? PIPE -
INSTALLER
INSPECTOR DRAWN BY