HomeMy WebLinkAboutDrain Layers Permit 82 Meadow Road �� TOWN orH WIDSOR E
* ' DEPART-Mg POLLUTION :CONTROL
B/P No.
Sou "Windsor, Con nee tICU
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List:No
DRAIN. LAY,ER'S .PERMIT
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ursuant to wutten app icatior' permission is hereby granted to the:.Licensed Drain-Layer darn h rera to Pe'tform
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the work indicated beow at
• _ r, obi the
i3@iY side _ ; igi�BeV
. at premises owned by ,�; i IE�
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whose-address is
and to _I Lay House Drain, Repair House Drain, Layalfain - Other `
for AssidOMMIoccwpancy
with Family'Units,"with acres
Type of Sewage to be connected under his permit:
f SANITARY SEWAGE ( ), INDUSTRIAL WASTES _ '+
Connection will be made with .
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Permit to be issued to +� at
r
the holder of.Drain Layer's License"No. " Permit will expire'on ;s
The undersigned Drain Layer hereby agrees to all the'terms and conditions set for on the permit and 4°e>resrerse sine
thereof. Applicaat has received Town Permit No. and/or C H D Permit No.
. .for street excavation.
SPECIAL.CONDITIONS
Signed- _
Connection Charge Paid Licensed Drain Layer
Issued by
Tag Collector -. r
Permit Fee:. Paid $ .
INSPECTION:" Check Number: _
INITIAL d (Sig)
•
FINAL t
(Sig) ,
APPROVED, #. (Date)
IPIAMCTOR" (Sig)
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