HomeMy WebLinkAboutDrain Layers Permit 999 Main Street ---- - —---- _ - - —W R - -------
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
- -- DRAIN LAYER'S PERMIT -
N° 1831
19
Pursuant to written applicatior, permission is hereby n¢red to the Licensed Drain Layer named herein to-perform
the work indicated below at ��� --16r on the
side, betwgen
at remises wned b T�J ,
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for v�(� �2��occupancy or use,
with /J'4 Family Units, with acres.
Type of Sewage to be co ected under this permit:
SANITARY SEWAGE ( �, INDUSTRIAL ZSTESk ), 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
ti Signe 0
Conne n Charge Paid ' �(� Lic
l� ensed Drain Layer
�
Issued by
r
Tax Collector
Permit Fee: Paid $ _/✓—
INSPECTION: Check Number:
INITIAL (Sig)
FINAL — (Sig)
—
APPROVED (Date)
1
(Sig)
INSPECTOR
N
c�
G12-
ot
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION '
OWNER
TYPE OF ORK
DATE ' .- PERMIT PIPE
INSTALLS
INSPECTOR . c DRAWN BY