HomeMy WebLinkAboutDrain Layers Permit 178 Kelly Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT
O 351
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drainjpayer named herein to perform
the work indicated below at 8 on the
side, between
at premises owned b
¢., 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 (V)/, INDUSTRIA WASTES :( ), OR ( )
y 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
C519(9 f t
Signea p�D7
Connection Charge Paid QQ 0 e sed Drain Layer
Issued by
.Tax Collector
Permit Fee: Paid $ _ � J
-_ INSPECTION: Check Nunber ��7Z)
~, INITIA-L (Sig)
FINAL (Sig)
APPROVED (Date)
r .
- (Sig)
INSPECTOR -