HomeMy WebLinkAboutDrain Layers Permit 10 Juniper Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B
South Windsor, Connecticut Li/P No.:
st No.: _
DRAIN LAYER'S PERMIT NO i458
19_ 'rs
Pursuant to written appI tior, perm ssion is her-IDA anted to the Licensed Drain Layer named y herein to"perform
the work indicated below at ��(ANf1 PE Q A#q1VE on the
side, between
at premises owned by -7_e1?7
wh-se address is
and to ,k Lay House Drain, Repair House Drain, Lay-Main, Other
for .1&2VTlAU-
occupancy or use,
with QN Family Units, with acres."
Type of Sewage to be connected under this permit:
SANITARY SEWAGE QK), INDUSTRIAL WASTES .( ), OR ( )
fi
Connection will be made with__
Permit to be issued to /C
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 y9 JP8 Licensed Drain Layer
78 Issued by
Tax Collector wp/
Permit Fee: Paid $
INSPECTION: Check Number: 7 9
INITIAL (Sig)
FINAL /� (Sig)
APPROVED �I �! "'IP (Date)
(Sig)
INSPECTOR
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CLEA�RYIEW DR IV i-era
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 6, 26
OWNER N\
TYPE OF WORK
DATE I- 2.8-i8 PERMIT PIPE ,-
INSTALLER
INSPECTOR �,t3 .� S L. DRAWN BY C X,