HomeMy WebLinkAboutDrain Layers Permit 168 Jacques Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut List.No.: -
--DRAIN LAYER'S PERMIT- N9 3112
L , 19 6Fs
`` -cj C a r ermission is he b granted��ed Drain Layer named herein to perform
Pursuant to written apphc R ,.p .
on the
,e work indicated below at
side, between
at premises owned by
ose address is
to Lay House Drain, Repair House Drain, Lay Main, Other '
occupancy or use,
acres.
th
Family Units, with
Type of Sewage to be connected under this permit:
ANITARY SEWAGE ( ), INDUSTRIAL WASTES :( ), OR ( )
onneetion-will-be made with - -_- - - - - ---- -- - --
Permit to be issued to 19
the holder of Drain Layer's License No.
. Permit will expire on
The undersigned Drain Layer hereby agrees to all the terms and'conditions set forth on the permit and the reverse side
I thereof. Applicant has received Town Permit No.
and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
I
I
Signed
� Licensed Drain Layer
;Connect* arge Paid a) �Z �3
�. Issued by
Tax Collector
Permit Fee: Paid $ _ •��
� INSPECTION:
Check' Number: �__
(Sig)
INITIAL
(Sig)
FINAL
- _ - -- - --(Date) - -- - --
APPROVED
(Sig)