HomeMy WebLinkAboutDrain Layers Permit 83 Lewis Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.: ZG I
South Windsor, Connecticut 5-c r�44
List No.: _
DRAIN LAYER'S PERMIT N? 792
04 rArt&c4,4k , 19. 7 S*
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at is 1, -riq 1 s 6.5 on the
�o•x, 14 side, between l .)i<..-r r r,,<g �' ! �.. a Cam. F rl-
at premises owned brrr�
whose address is s-4,_,Q
and to C Lay House Drain, Repair House Drain, Lay Main, Other
for k=` 'r"3 z- -TM j r- occupancy or use,
with G ns,,; C 1} Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (V), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with c rY`imc w (46a) 5 %Lll tMT d .r 12 9&W r ;
Permit to be issued to WOba_I,
the holder of Drain Layer's License NoA,/ n- 2.07645' Permit will expire on GG 40, ,` 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 '� f ''-`,G�
Connection Charge Paid ' icensed Drain Layer
Issued by
Tax Collector - 7`
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL f (Sig)
FINAL (Sig)
APPROVED f (Date)
(Sig)
INSPECTOR
Y