HomeMy WebLinkAboutDrain Layers Permit 100 Jacques Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER' S PERMIT N? 3115
, 19 -3 -
Pursuant to written applicatior, permission is h reby granted to the Licensed Drain Layer named herein to perform
the work indicated below at lob % C 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- -_ --
9
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
t 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 p(J Licensed Drain Layer
- - —/ u�-- ✓� Issued by
�) T Collector
Permit Fee:. Paid $
INSPECTION: Check Number: ���
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
- --- -- - - — - (Sig)
--- - — INSPECTOR