HomeMy WebLinkAboutDrain Layers Permit 103 Jacques Lane TOWN. OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT 0 3406
a , 19 � J`
icy Sac
Pursuant to written ap �catt r, permission i ,hereby granted to Licensed Drain Layer named herein to perform
the work indicated below at wa- 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`( ), 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
y �`�
/1 Signed
Connection Charge Paid -��OD O O Licensed Drain Layer
r
Issued by
Tax Collector
Permit Fee:. Paid $ '16
INSPECTION:- Check Number: 1�7
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR