HomeMy WebLinkAboutDrain Layers Permit 199 Kelly Road Y _
✓. ? TOWN OF SOJJ'M WI.N DS R
DEPARTMENT OF PI LLUT.ION CONTROL
` South Wind0 , onnecticut
DRAIN LAYER'S PERMIT tf 325
u
s
. .. 19
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Pursuant to written application, permission is hereby granted to the Licensed Drain.Layer named,herein to perform
the work indicated below at��;, � '
on the
r side - w""'°�-
r - at premises owned:b
whose address is
and to -ALLay House Drain, Repair House Drain, Lay 1V4ain; Other
for occupancy or use,
wither 0` Family Units, with acres.
Type of Sewage to be connected under this permit:
ASANITARY SEWAGE) INDUSTRIAL WASTES; OR
Connection will be made_with 5 -• ..� .,, ;
'
` Permit to be issued to—
the holder of Drain Layer's License No. WHOM Permit will expire on I9
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit an theerreverse side'
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street`egcavatipn,
SPECIAL`CONDITIONS '
Signed,..,
Connection Charge Paid' , Licensed Drain Layer
--. - - (Sig) . Issued:by
Tag Collector ,
Permit Fee: Paid
INSPECTION:
INITIAL. Am (Sig)
FINAL -- (Sig) ,
APPROVED T _- (Date)
iL (Sig)
INMECT