HomeMy WebLinkAboutDrain Layers Permit 200 Laurel Street (3) TOWN OF SO1TH. .WI N DSOR
DEPARTMENT 'OP POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: •
DRAIN LAYER'S PERMIT 573
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at _; on the
side, between
at premises owned
whose address is AM At*
and to Lay House Drain, Repair House Drain, Lay 4in, Other
for 04.*,:..,,s, .
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 r
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 pernff and e reverse side'
thereof. Applicant has received Town Permit'No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Layer
Z
` ' `� Issued by .ts �....
R
Permit Fee: Paid $
INSPECTION: Check Number: _
INITIAL 1 rf' "
� ' � .:(Sig)
FINAL (Sig)
APPROVED
(Date)
INSPECTO