HomeMy WebLinkAboutDrain Layers Permit 15 Larkspur Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYEVS PERMIT O 3100
Pursuant to written applicatior, permis ion is hereby granted to the Licensed Layer named herein to perform
the work indicated below at ll++l on the
side, between
at premises owned b Q
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 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the revrse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
y� � Signed
Connection Charge Paid d ,� P43 Licensed Drain Layer
- - Issued by
_T Collect r
,t•( Permit Fee: Paid $
INSPECTION: Check .Number: ► ' ��
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
-'
ig
-
INSPECTOR