HomeMy WebLinkAboutDrain Layers Permit 988 Main Street -TOWN Of.. i OUT =-W-1
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DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2351
/d" , 19
Pursuant to written applli}catior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at loc� GU/YL on the
side, be een
at premises owned by
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
��JLf
l q�� Signed
Connection ChargeePPaid QQ •(�(� Licensed Drain Layer
P`� L Issued by
Tex Collector /
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
I
t
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER c
TYPE OF WORK ►{'
DATES G; ,> rS/ PERMIT c; , PIPE
INSTALLER 4L f S tv, i
-INSP_E_CTOR (--DRAWN BY