HomeMy WebLinkAboutDrain Layers Permit 54 Jacques Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut a
List No.: _
DRAIN LAYER'S PERMIT NO 2180
54 Sac I,4AX-_ ' 19
Pursuant to written applicat rr'b , ermiss on is hereby grant to the Licensed Drain Layer named herein to perform
the work indicated below at, .7
on the
side, b t een
at premises owned
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
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
Signed:;z
ge Paid �.'v e 2/jU Licensed Drain Layer
Issued by
- r
dZ.
Permit Fee: Paid $
- INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
— -A-PPROVED-- `--- --- - - - - - ----------� -
-(Sig) -- -
INSPECTOR - --