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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 N0 3397
1
3 I jet
Pursuant to written applicatt mission is hereby granted to the 'censed Drain Layer named herein to perform
the work indicated below at on the
side, betw y�
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
// p Signed
Connect arge Paid 4o` p 4� Licensed Drain Layer
- - - Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: -
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig) - - - - -
INSPECTOR