HomeMy WebLinkAboutDrain Layers Permit 80 Horizon Circle TOWN- OF S6tl� WI N DSOR
DEPARTMENT OF` POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: 09'
DRAIN LAYER' S PERMITp 543
0412-3 719 74
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at i�d, �10.2/2aq L-T- 22) on the
•side, between
at premises..owned b
whose address is es
and to y Lay:House Drain, Repaii 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 (✓), INIDUSTRIAL WASTES ( ), OR
Connection will be made with.
Permit to be issued to yer �cAR�
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees t6all•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 4IV3 '74 Licensed Drain Layer
¢S9 Issued by /�4t.nif
Tax Collector
Permit Fee: Paid $INSPECTION: Check Check-Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED ,_. (Date)
(Sig)
INSPECTOR