HomeMy WebLinkAboutDrain Layers Permit 206 Laurel Street TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: 4 ''
DRAIN LAYER'S PERMIT N? 573
4�2 f �4' ' ' 19— -st—
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at__ ''` t` on the
side, between
at premises owned b
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for �e� occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( >j INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
a
Permit to be issued to k-
the holder of Drain Layer's License No. Permit will expire on .2 2 19 741
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and fhe reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signea
Connection Charge Paid Licensed Drain Layer
Issued by---�A � - -� '_� u f"rZ
Tax Co lect� � '�
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL Yt tr' 1 F ' C`i (Sig)
f
FINAL 1"
�' ,- (Sig)
APPROVED �.. �;' (Date)
~ „ (Sig)
INSPECTO "`
K _
N
1�
NOTES
SOUTH WINDSOR POLLUTION CONTROL
LOCATION C> G�lz1 ri �s —
OWNER %'e:�.s►� vry A:�r
TYPE OF WORK
DATE - ,y PERMITS PIPE iic,
INSTALLER
INSPECTOR e\f' DRAWN BY ,f