HomeMy WebLinkAboutDrain Layers Permit 34 LeFoll Boulevard le- V#k, TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.:
DRAIN LAYER'S PERMIT NO 1704
1 -7 19
Pursuant to written applicatior, permi sion is hereby granted to the Licensed Drain Layer name herein to-perform
the work indicated below at
on the
side, between
at premise owned byeofz
,
whose address is
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 con under this permit:
SANITARY SEWAGE ( �", I1vDUSTRIAL WASTES .( , OR
Connection will be made with w
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—&_ 7q 1,
Licensed Drain Layer
00,
O � Issued by lei
Tax C041/
ollector
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
-----APRROVED------- -- -- -- ----- — (Date)
-- --- -
P
IQ SPE OR (Sig)
J
N
C
I p�
NOTES SOUTH WINDSOR_. POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY
- - _ GOB ar - E - -