HomeMy WebLinkAboutDrain Layers Permit 1544 Main Street r W TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.:
DRAIN LAYER'S PERMIT No , 1973
i iw, , 19
Pursuant to written application,, permission is hereby granted to the Licensed Drain Layer named he to"perform
the work indicated below at l �T 7� �//� �� J, (-d on the
side, between
at premises owned by 05�ee/
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: rCl gat- �A. r
SANITARY SEWAGE ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with /;/ ,�I/,c
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
Signe '
Connection Charge Paid -/��. Licensed Drain Layer
.� Issued by
fax Collector
Permit Fee: Paid $ _--ZL• _00_
INSPECTION: Check Number:
INITIAL (Sig) 7�ii/G•+-� WrS✓�%Cc,�f�G, t
FINAL (Sig)
- - - APPROVED - - - - (Date)
(Sig)
INSPECTOR
V
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER 1-(,en/
TYPE OF WO
DATE 1 PERMIT PIPE
INSTALL191C
INSPECTOR DRAWN BY