HomeMy WebLinkAboutDrain Layers Permit 983 Main Street .+-w--,—rt.:—I!a ..-.ar;;r—?-,Vi.'''T y-9p y"p :.I:,
DEPARTMENT OF POLLUTION CONTROL Bhp No.:
South Windsor, Connecticut
List No.: _
3167 -
Pursuant to written appl(iccatiioor, permission is h r y granted to the Licensed Drain Layer named herein to perform
the work indicated below at !�J ��_ on the
side, betwe
at premises owned b
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
Connection Charge P 7�b• Q Licensed Drain Layer
Issued by -
Tax Collector _
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig) vv
FINAL
APPROVED (Date)
(
INSPECTOR