HomeMy WebLinkAboutDrain Layers Permit 1696 Main Street TOWN OF SOUTH WINDSOR
i DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut a o
List.No.: /
- - DRAIN LAYER'S PERMIT - —
N° 1921
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by— L!//4-1—/~5
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with 423d Family Units, with acres.
Type of Sewage to be co cted under this permit:
A
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
Connection Charge Paid O d Licensed rain Layer
2!!!! Will p��lle-)e�Issued by
Tax Collector
Permit Fee: Paid $ _ U 0
INSPECTION: Check Number: /3 0 0
INITIAL (Sig) c(/'.//i'a-,) S
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FINAL (Sig)
APPROVED (Date)
l' (Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL4
LOCATION �.
OWNER
TYPE OF WORK ' a
DATE PERMIgPIPE 'r
INSTAL R
INS CTOR DRAWN BY
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