HomeMy WebLinkAboutDrain Layers Permit 109 Jacques Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT
O 3057
loqJ "missionjis , 19
Cf C'
Pursuant to written ap licatior, p hereb ranted to the Licen
Y g sed Drain Layer.named herein to perform
the work indicated below at
on the
side, between
at premises owned by4 .�J. e,r�1Alit
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 ( ), 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 Charge Paid 00 d-V -A,)V3j,, Licensed Drain Layer
Issued by
� �• x Collect r
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
Date)
lSi&)
INSPECTOR
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