HomeMy WebLinkAboutDrain Layers Permit 97 LeFoll Boulevard TOWN OF :SOUTH WI N DSO
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.: rK C3)-��
List No.: _
DRAIN LAYER'S PERMIT NO 2149
19 _
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 4 4j �—on the
side, between
at premises owned bye- ,, ,iwhose 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 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 C)0Licensed Drain Layer
ez 2&2 Issued by
Tax Collector l
Permit Fee Paid $ /_g"0 0
INSPECTION: Check Number:
INITIAL (Sig) !�
FINAL- (Sig)
API?ROVFn (-ate)
(Sig)
- — -- - INSPECTOR_ , _
N
t
( I
I
NOTES SOUTH kZLNDSOR POLLUTION CONTROL
LOCATI 3► e �.
OWNER 4c"
TYPE OF WORK y ��
DATE `• #` ? PERMIT 1 PIPE ;
INSTALLER
INSPECTOR f DRAWN BY