HomeMy WebLinkAboutImported on 5/12/2009 at 8:23:41 PM TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2573
19
Pursuant to written applicatior, p
ermission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �f,��`, /�QG j(
on the
side, between
at premises owned
whose address is
and to Lay House Drain, Repair House Drain, La -Main,Man 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 1
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 Licensed Drain Layer
��Jf�YI'7�LF L) Issued b
Tax Collector y
\' Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL
(Sig)
FINAL (Sig)
APPROVED (Date)
\ INSPECTOR (Sig)
I