HomeMy WebLinkAboutDrain Layers Permit 264 Kelly Road TOWN OF aQ
!JTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No . T
South Windsor, Connecticut
List No.: -S�"6dyU—
DRAIN LAYER'S PERMIT N? 514
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Rally IM_ on the
0031th side, between 0-k
at Oremises owned by L�66
whose address is arerw
and to Lay House Drain, Repair House Drain, Lay Main, Other
for Asl occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with__ad-t 1-yegb (6) V— C— p,
Permit to be issued to ♦AM W=11 ow ki
the holder of Drain Layer's License No�, mi
Permit will expire on rob 19�
The undersigned Drain Layer hereby agrees to al the terms and conditions set forth on the pert and"the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS Dralft Ingr tad MUMS inrush Mtt h20kftt'i M"t* tmgk
Signed r` {...�c•�., E�.✓� - ". i. i
Connection Charge Paid la^,#473 Licensed Drain Layer
P"• so 11110"Is Issued by _WY31`i A. Starlmeather Jr,
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL r �'7� (Sig)
FINAL `" / (Sig)
APPROVED _,tp / .' �' (Date)
(Sig)
INSPECTOR
I
N
�J
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 4// -( /=L.�,i
OWNER
TYPE OF WORK
DATE 2 l 7 PERMIT ._ % PIPE-4-�,'f:'
INSTALLS
INSPECTOR DRAWN BY � '`