HomeMy WebLinkAboutDrain Layers Permit 43 Jacques Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
3a-O 0
List No.: _
DRAIN LAYER'S PERMIT N? 2129
19
T3 Dc '
Pursuant to written ic tip' 'or, permission is hereby granted to the Licensed Drain Layer named herein to perform.
the work indicated below at Jv- on the
side, betw
at premises owned by
w o4O-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
Signed
Connection a Paid Licensed Drain Layer -a
Issued by
ax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
i APPROVED - - --- --- — - - ___ - - -- - - - - -- - -- ---tote)
--- --- _ (Sig)
INSPECTOR
1