HomeMy WebLinkAboutDrain Layers Permit 115 Jacques Lane . ,. .� .. •'rq4-3R�sT„R.�-cga..ry,p,'Flepz; ^'.-�v+s - .- �C
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 3082
i l -l 19
Pursuant to written applicatior, permission is hereby granted tothe LicgnsedDrain Layer named herein to perform
the work indicated below atL !— # on the
side, betwe
at premises owned b C .
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 willbe 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 13 Licensed Drain Layer
- Issued by
a Collectp
Permit Fee:. Paid $ _ _V
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
- --- _ __- -(Sig) -
INSPECTOR