HomeMy WebLinkAboutDrain Layers Permit 185 LeFoll Boulevard 77
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT No. 2724
'Al
Pursuant to written applicatior, permission is hereb granted to the Licensed Drain Layer named.herein to perform
the work indicated below at�iG on the
/ --side; between
at premises owned by ' ? l
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 INDUSTRIAL WASTES� 1 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
Z&c
Signed
Connection Charge Paid Vt. [; o Licensed Drain Layer
L l uC Issued by
Colle for
Permit Fee: Paid $, e
- INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
— - - _(Sig)--
-__ INSPECTOR