HomeMy WebLinkAboutDrain Layers Permit 10 Kent Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut r !s List No.: _
DRAIN LAYER'S PERMIT NO 2115
b to S -) Igo
Pursuant to written application, ermissi//on is he by g anteJdsto the Licensed Drain Layer named herein to perform
the work indicated below at 6 (P /l L°1�f /�(V!Z° on the
side, between
at premises owned by f
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on Ig
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'HD Permit No.
for street excavation.
SPECIAL CONDITIONS
S bU
Signed
Connection Charge Paid �[7a Licensed Drain Layer
Tax Collector Issued by
D�
Permit Fee: Paid $
INSPECTION: Check Number:(�,11�
INITIAL (Sig)
FINAL ' (Sig)
APPROVED (Date)
(Sig)
INSPECTOR