HomeMy WebLinkAboutDrain Layers Permit 19 Jean Lane .. _ .- .. �q;.. Ji. row,. ac'•, ' ,,. .. •ram :.
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N? 285•0
AAZI 19g3
Pursuant to written applicatioorr, �permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at /VJ"/ 3 L 9 Ztan
on the
side, between
at premises owned by 'f
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
i
/� Signed
Connec ' Charge Paid Licensed Drain Layer !
Issued by
Tax Collector
Permit Fee: Paid $ _ S'- S 2d �" 3
1
INSPECTION: Check Number:
INITIAL (Sig) y
FINAL (Sig)
APPROVED (Date)
(Sig) -
INSPECTOR