HomeMy WebLinkAboutDrain Layers Permit 250 Kelly Road (2) TOWN OF SOUS H WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.: —ro.X
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 507
NOT* 20 , 1971-
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at aRA K*3 1 at Rdon the
north side, between A�lr St- & Me== TJwA Id-ne
at premises owned b
whose address ist♦
and to X _Lay House Drain, Repair House Drain, Lay Main, Other
for residential occupancy or use,
with One Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( X), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with d 64neh V.C.P. t.�+370 o �����A��t��jat Q�
KM i 1 5i Takera 7 on th ?.50
Permit to be issued to Adam W4 em{awaki
the holder of Drain Layer's License No._ W% W" Permit will expire on Jan• 20 192_
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 Drain layer to pump crush and backfill a/Dtic tank
Signed
Connection Charge Paid // 7 Licensed Drain Layer
Issued by _Ralph a• Staliw*athor jre
Tax Collector
Permit Fee: Paid If
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
a (Sig)
INSPECTOR `
ti
1
N
�1'
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT S-o PIPE
INSTALLER
INSPECTOR DRAWN BY