HomeMy WebLinkAboutDrain Layers Permit 42 Kelly Road (2) TOWN OF SOUTH WI N DSOR ..
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN LAYER'S PERMIT O ®5 '
259
Pursuant to written:application,permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at `t 4�; ;`,, j Z G J on the
side, between
at premises owned b
whose address is
and to ✓ Lay House Drain, Repair House Drain, Lay Main, Other
for C. rl =..,*,'tr occupancy or use,
with �' a iv Family Units, with acres.
�} !` 0-
Type of Sewage to be connected under this permit:
6ANITARY SEWAGE., INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be issued to AJ
the holder of Drain Layer's License No. Permit will expire on ;
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the perms nd the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for sireet`excavation.
SPECIAL CONDITIONS— c �+
r
Signed�� � ,� � •
Connection Charge Paid $ .¢ = License Drama Layer
� f` (Sig) Issued by
Tax Collector
Permit Fee: Paid $ /5.00
INSPECTION:
INITIAL /!r'/ (Sig)
FINAL A4 S (Sig)
APPROVED C,/.1���? (Date)
(Sig).
I PECTOR
V
N
nT
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER r✓� oar �t�
TYPE OF WORK s� er oi�/pG
DATE G 7 - PERMIT .25c PIPEG'"
INSTALLER Lm So„/
INSPECTOR ) DRAWN BY