HomeMy WebLinkAboutDrain Layers Permit 263 LeFoll Boulevard WTI
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT M 3081
ff / b , 19
Pursuant to written app icatior, permis ion is her granted to the Licensed Drain Layer named herein to perform
the work ic}dicated below at � ��03 on the
side, between
at premises
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 .( ), 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
hnnectioon Charge Paid �(/�D� Licensed Drain Layer
T .
Issuedby
T Cllector /
�J Permit Fee: Paid $ v
INSPECTION: Check Number:
INITIAL (Sig)
FINAL
APPROVED (Date)
-_ - (Sig)
INSPECTOR _