HomeMy WebLinkAboutDrain Layers Permit 1005 Main Street --- -TOWN-- OF�SOU TH--W- DSO - -- ---- -- - -----
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: �6.12-1
DRAIN LAYER'S PERMIT - -- -
N° 1919
4Z � , 19
Pursuant to written applicatior, permission is hereby granted to the Lic s d Drain Layer named herein to perform
the work indi ated below at Z 626 Z on the
side, between
at premises owned b
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with —43AA.-Eamily Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ), INDUSTRI _L WASTES ), OR ( )
Connection will be made with r�
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
C may°yf Signed
Connection Charge Paid y�0. License Drain Layet
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
- rn�lr —
APPROVED (Date)
00- -- 0�5 X�a t ok 04
(Sig)
INSPECTOR
N - �
Jew
J v`
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ' r
OWNER
TYPE OF WORK
DATE RMIT. PIP vC
INSTAL MR'
INSP R DRAWN BY