HomeMy WebLinkAboutDrain Layers Permit 292 Kelly Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION' CONTROL
B/P No.:
South Windsor, Cognee'ticut,
List No.:
DRAIN LAYER'S PERMITp 603
.�; , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work,indicated_below at__ � on the
Iota side,,between , -'
at premises owned b
whose address is
and to _Lay House Drain, Repair House Drain, Lay-Main, Other
OWNfor' ' ' 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`
- —s
the holder of Drain Layer's License No Permit will expire on 1
The undersigned Drain Laye'rliereby agrees to all the terms and conditions set forth on the pe xt d the reverse s
thereof. Applicant has received Town Permit No. and/or C HID Permit No. -
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Layer
Issued by A* 11"Mm"emw
Tag Collector
Permit Fee:. Paid 40LAft --
INSPECTION: Check Number:"
INITIALy'. y:' s, (Sig)
FINAL
APPROVED ;� ',�,X (Date)-------—--� -- ---- _
(Sig)
-
INSPECTOR