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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT NO 3280
5.- , 19
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Pursuant to written applicatior ,n�.
permission is hereby gra d to the Licensed Drain Layer named herein to perform
the work indicated below atl�& V
on the
side, between
at premises owned by—
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 ( j, INDUSTRIAL WASTES OR ( )
-- --= Con-nection-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
Connec n Charge Paid S/ Licensed Drain Layer
Issued by
ax Collector
Permit Fee: Paid $ -s�G
INSPECTION: Check Number: �!
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
-- - Sig_ - - -- - - - --- -
INSPECTOR