HomeMy WebLinkAboutDrain Layers Permit 12 LeFoll Boulevard TOWN OF SOUTH WI N DSOR
.-DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _ Z 6/ G 12 _
DRAIN LAYER'S PERMIT NO 1702
19�
Pursuant to written applicatior, permi sion is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 79 on the
side, between IG �1�. �V s
or
at premis ownedIr b T
w ose address is01 OF
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 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 — "7 Licensed Drain Layer
Issued by
ax Collector
04
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
�Date)
---
(Sig)
INSISECTOR
a
N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION �f I s ,, J►� �r
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY
- --- L p
N
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0
s
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK ,
DATE ld- PERMIT PIPE,6 ��P
INSTALLER c-o/✓
INSPECTOR p DRAWN BY L}