HomeMy WebLinkAboutDrain Layers Permit 91 Laurel Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.:
DRAIN LAYER'S PERMIT N
° 1432
19'_
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 9 f I_QUFjl, '
_.on the
side, between
at premises owned b ,4 14 A
whose
and to _KLay House Drain, Repair House Drain, La Mi
Yan Other
for
occupancy or use,
with Family Units, with
acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE Oi, INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with Pl/�
Permit to be issued to AG 4 e W_s k 1
the holder of Drain Layer's License No. Permit will expire on 1
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.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Layer
ax C ollector�O _/,9- Issued by
T
Permit Fee:. Paid $ _ 'y
INSPECTION: Check Number:
INITIAL (Sig)
FINAL
(Sig)
APPROVED <+ '7 (Date)
PECTOR (Sig)
y 4
N'
N s
o/ I/It
v%LE'i'
r
q P
vi r-LI
cO.
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY