HomeMy WebLinkAboutDrain Layers Permit 68 Kelly Road (2) s_6/ 4 _
TOWN OF w.SOVILK WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor Connecticut
List No.: 940166
DRAIN LAYER'S PERMIT XO 210
18 Na►r ; 19 ??�
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at fig Ml.y Sma (ies! 20 on the
j*j*h side, **=AM of X41 't ftod OW Willow Atno ,
at premises owned b
whose address is arm+
and to _1_Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with 00411 W Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE) INDUSTRIAL WASTES, OR
Connection will be made with d+1Amoll (611) 34-afts
Permit to be issued to V110 Pe %!r
the holder of Drain Layer's License No.— �'�) . Permit will expire on 18 dam► 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 -e' d Town Permit No. and/or C H D Permit No.
for street excavation
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SPECIAL CONbiNf NS ar" "Ye' to W"e Oro* "d b&AddlU motto �tau�ks
�Q�� Signed
Connection Charge Paid �*�"/9 Licensed Qlain Layer
C Collector Tax C i (Sig) issued by ! • +Trs
T
Permit Fee: Paid $ ��j.Qp�
INSPECTION: Pftborl
*TYo].udoo mtra tN der Saftrda
INITIAL (t�ig).
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
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