HomeMy WebLinkAboutDrain Layers Permit 26 Imperial Drive "' 'T0 / 10OUTH W1 N DSOR
DEPARTMENT' OP" POLLUTION CONTROL
South>Wicjdsor, Connecticut
ZAMA�" � DRAIN LAYER'S PERMIT O No*I ram'' 8 8
f . j�r
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at _ ," on the
' side, between
at premises owned by
whose address�is
and to -,_Lay House Drain, Repair-House Drain, Lay Main,. Other
for f�■i diMMEMO" occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SAJNITAA1 S .;06E. ,INDUSTRIAL WASTES, OR
Connection will be made with,
Permit to be issued to 111a I� �aM
the holder of Drain Layer's License No. _ Permit will expire on. JALVIP 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_- Aids AMR !a
Signed_ err.
Connection Charge Paid '` Licensed Drain Layer
— e (Sig) Issued by S ti
Tax Collector
Permit Fee:. . Paid $ MLw—
INSPECTION: l�M�R _
INITIAL (Sig)
FINAL "" (Sig)
APPROVED KW* IM (Date)
- (Sig) - -
OR