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HomeMy WebLinkAboutDrain Layers Permit 1076 Main Street - - - - - TOW-N - ©F SOUTH- W1 N DSOR _ r " DEPARTMENT OF POLLUTION CONTROL � B/P No.: South Windsor, Connecticut List.No.: DRAIN LAYER',S PERMIT NO 1812 f} Y Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at l O -7 t v� on the side, between at premises owned by V A '-A d,C-r (11 e rl 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 (/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 �� Signed Connecti harge Paid /f��5 License ran La er C0 Issued by. Tax Collector Permit/Ce. Paid $ /SPECCTION: Check Number: 2/ INITIAL (Sig) FINAL (Sig) APPROVED -- - te) -- (Sig) INSPECTOR f � I �JI i 4� J� i f: i I NOTES ) , /� SOUTH WINDSOR POLLUTION CONTROL F_ Q LOCATION o OWNER i TYPE OF WORK DATE PERMIT PIPE INSTALLER INSPECTOR DRAWN BY