HomeMy WebLinkAboutDrain Layers Permit 1772 Main Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut ..�
List.No.: _�
-DRAIN LAY-ER',S- PER-M-1T.. -- ..
N° 1914
l6 / 2---Z , 19 22_
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 17 7 2 ! �, ,� j�. 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 Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES ( ), OR
Connection will be made with plr e i C
Permit to be issued to r
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
Signe
oa4,.-
00
Connection Charge Paid (,_ Licensed rain Layer
Issued by
Tax Collector
Permit Fee: Paid $
O
INSPECTION: Check Number: �—
INITIAL (Sig) f�� ��•� S
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
1
1
f
N
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION „
OWNER
TYPE OF WORK C r; c
DATE ' *?a PERMIT PIPE
INSTALLER
INSPECTOR!-T 1 DRAWN BY