HomeMy WebLinkAboutDrain Layers Permit 1375 Main Street - TOW-R. -OF. -SOUTH.----WLN.QSQR -_ _-- �-
DEPARTMENT OF POLLUTION CONTROL
South B/P No.:Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 2433
E / 19 6(-1
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at , �� CGf/vC, on the
side, between
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
T/
Signed
Connection Charge Paid QQ _®d Licensed Drain Layer
Issued by
(.i7.Tax Collector
Permit Fee: Paid $ _��v�_
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED
--- ------ - (Date)._
INSPECTOR (Sig)
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NOTES , SOUTH 14INDSOR POLLUTION C0-l\7TROL
LOCATION �� '�_E,
i OWLNER 1'�Y y-,1 I, 7.
Er TYPE OF WORK
DATE ` F I P RMIT J ?• PIPE : .:
INSTALLER
INSPECTOR DRAWN BY r'