HomeMy WebLinkAboutDrain Layers Permit 156 LeFoll Boulevard TOWN OF SOUTH WINDSOR
614 DEPARTMENT OF POLLUTION CONTROL
W(w (� South Windsor, Connecticut B/P No.:
5 U� List No.: _
DRAIN LAYER'S PERMIT
p 2577
0 � \�, 19
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer named herein to perform
the work indicated below at
on the
side, between J y
at premises owned by r�1
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 connected under this permit:
SANITARY SEWAGE ( j, 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 t e reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL.CONDITIONS
H ) Signed
Connection Charge Paid / Licensed Drain Layer
�.Jx Co let Issued by
Permit Fee: Paid
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
�y,