HomeMy WebLinkAboutDrain Layers Permit 4 Juniper Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _a� l �—
DRAIN LAYER'S PERMIT NO 1522
Pursuant to written applicatior, permissiop is hereby granted to the Licensed Drain Layer named he to perform -
the work indicated below at / 4
on the
side, between
at premises owned by /
whose
r
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 V, �E V
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 Licensed rain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: ��
INITIAL (Sig)
FINAL
(Sig)
APPROVED /j7-2(� �� (Date) -
(Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Lo/ e
OWNER M
TYPE OF WORK se hnecai',
DATE /0-7-6- 7 PERMIT l5zz. PIPE "PVc
INSTALLER
INSPECTOR DRAWN BY