HomeMy WebLinkAboutDrain Layers Permit 112 Jacques Lane _ �. .- �+.au w...�++. ...---w..f.�..,... «.;m'•,-.*s'-„r,•�..^n�...Z.^.:,--4^r.'•>5�'r��i.'�S `PTii�r-.p.'�'rx.,�� ..n:
TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
' B/P No..
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 3166
Pursuant to written ap liCca''EEior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at G� /L � on the
side, be ween
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
o Signed
Connection Charge Paid'W. b 0-11 6)(1q4 Licensed Drain Layer
T' Issued by
x Gollecy6}�
(�/� Permit Fee: Paid $
r INSPECTION: Check Number: _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date) -- --�- ---
INSPECTOR -