HomeMy WebLinkAboutDrain Layers Permit 66 LeFoll Boulevard TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut ��
List.No.: _
DRAIN LAYER"S PERMIT NO i892
O�.�, �t vd f ' 19
Pursuant to written applicac'or, permission i here} ranted to the Licensed Y✓g, a —Drain- Layer named herein to perform
the work indicated below at ��(�C �/'-�i�
on the
side, between
at premises-owned by ..I, A Cl
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Othe
for � �
4; 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
dZ Signed �-
Connect* harge Paid ��i��f '��'—Licensed Drain ayer
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number: z
INITIAL (Sig)
FINAL (Sig)
-APP-ROV-RD--- --- ---3Q1 - -- - -- --- ----(Date r-- - ---- - ------- -
(Sig)
INS P ECTOR
t
rl
a
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION L 6Z ,
OWNER '" fe ;r
TYPE OF WO _ w a
DATE PERMITPIPE C.
INSTALLER
INSPECTO RAWN BY a