HomeMy WebLinkAboutDrain Layers Permit 75 LeFoll Boulevard TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: e7 56 h
DRAIN LAYER',S PERMIT NO iSOi
75 l.p--PD l i -6 I vd . - P- ) . ' 19 7 �
Pursuant to written applicatiorr,, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at G.tl% 44 67 09z on the
side, between
at premises owned by _��
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for ' occupancy or use,
with E1 ram-" Family Units, wi`th/ acres.
Type of Sewage Vbbennected under this permit:SANITARY SEWAGE ( DUSTRIAL WASTES ( ) OR ( )
Connection will be made with (C
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
icece I� /4��
'/ Signed
5
Connection Charge Paid D0 O U ttLic-ensed rain La er .
-Tax Collector Issued by
Permit Fee:. Paid $ je, _
INSPECTION: Check Number:
INITIAL (Sig) +
�'G 64-
FINAL - (Sig)
- -- --- — --- � s f,
- (Sig)
- - - INS TOR -fl-
r
i
� OD
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION JOE 2 L o
OWNER
TYPE OF WORK
DATE a / PERMIT PIPE
INSTALLER '
INSPECTO DRAWN BY