HomeMy WebLinkAboutDrain Layers Permit 69 Kelly Road TOWN OF -SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No::
South Windsor, Connectigut --31 9 80
List No.: _
DRAIN LAYER'S PERMIT N? 2100
5- ol , 19 �v
Pursuant to written appli/c-atior, per issfsign is he yp y granted to the Licensed Drain Layer named herein to perform
the work indicated below at K,A . l on the
side, between
at premises owned by i 10Q� /;, mol7di It ! i ly ►�
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 ( j, 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
/lryh /� ai-
Signed
Connection Charge Paid �tv _ Licensed"Drain Layer
Issued by
Tax Collector
S"'�Y go Ik,2160
Permit Fee:. Paid $
INSPECTION: Check Number: Vy
INITIAL (Si ) �,1*
FINAL (Sig)
- APPROVED - --
-- (Date)
--- - - - - (Sig)
INSPECTOR