HomeMy WebLinkAboutDrain Layers Permit 67 LeFoll Boulevard r TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut ` ,r ,
List No.: �p I
DRAIN LAYER"S PERMIT Np i802
r7 Le-A r) w U
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ��(} /lj A �/� %�L� on the
r JL— side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, gther
r
for /7� occupancy or use,
with C12U Family Units, with acres.
Type of Sewage to be c ted 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 an the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Q1reei,P_�
Signed
Connection Char e PaidY O U U fd
ensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $ l ' D 1_
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
-
APPROVED - - --- - - - -- ---�5 -
�� - -- ---- (Date) ---- ------- ----- ---
INSPECT (Sig)
N
4-
ft
I
l CA
a
v s
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION I o L c
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY