HomeMy WebLinkAboutDrain Layers Permit 67 Jacques Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut 3ad�
List No.: _
DRAIN LAYER'S PERMIT N? 2131
, 19
Pursuant to written.appl a�permission hereby granted p
to a Licensed Drain Layer named herein to perform
/
the work indicated below at fs on the
side, bet en
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
Connection ge Paid Licensed Drain Layer
Issued by
Tag ollector
d�
Permit Fee: Paid $
INSPECTION: Check Number: f �
INITIAL (Sig)
FINAL (Sig)
— - - --- - - - (Sig) -- -
--- - INSPECTOR -