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HomeMy WebLinkAboutDrain Layers Permit 62 Jacques Lane TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL South Windsor, Connecticut B/P No.: 3d List No.: _ DRAIN LAYER'S PERMIT NO 2150 19� Pursuant to written aliplicado/r, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at 1.r� v7� ,f/� /��Ile„ /A /}7 eff on the side, between at premises owned by 4M M E 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 G p Signed Connection Charge Paid QU. Licensed Drain Layer sued by Tax Collector Permit Fee:. Paid $ INSPECTION: Check, Number: INITIAL (Sig) FINAL (Sig) APPROVED- - -- -- _ - - - ---INSPECTOR (Sig)_ --- -- ----- — ---- r . I + -y Sf)UTM W IN:)SOP, PO'J_UTION CON POl_ IPIPE INS TALLER V kl�l I JN:©ECT�R C_ OPAIAJN(3Y z