HomeMy WebLinkAboutDrain Layers Permit 1503 Main Street i TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut ,7
List.No.: l✓
- - - ---DRAIN LAYER"S RERMIT- - - ----- - - - -- --- -- - N° 1911
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 1 s 0 7�/f 4.4, I—A 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 0--XA, 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
�S^v Signed
Co ection Charge Paid 4160 •D C) Issued by Licensed Drain Layer
Tax Collector
/7//
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig) �Sv 3
FINAL (Sig)
APPROVED (Date)
_ INSPECTOR (Sig)
r p
!•sd 3 �i�A/ ' /�
�5
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Ar®3
OWNER
TYPE OF WORK
DATE —o,4-7s PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY
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