HomeMy WebLinkAboutDrain Layers Permit 1475 Main Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
Li
South Windsor, Connecticut ,_, -0
st.No.: _�
D.RA-tN LAY-ER'S .PLRMLT
-_
N° 18'79
19 -7 2
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated be r w at �t�� on the
side, between
at premises owned by—
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for /IO.� occupancy or use,
a
with _Family Units, with acres.
Type of Sewage to bennected under this permit:
SANITARY SEWAGE (!/`, INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with /3 7 fr /` !✓
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
Signea
Connection Charge Paid Q® a Licensed Drain Layer
Issued by _
Tax Collector
�0Y 1 Permit Fee: aid $ 1S b
h-e _
INSPECTION: Check Number:
INITIAL (Sig)dvfei L D✓►S�
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
�a
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION $
OWNER
TYPE OF WORK " 4
DATE PERMIT PIPE Y
INSTAL
INSP OR I DRAWN BY