HomeMy WebLinkAboutDrain Layers Permit 120 Mountain Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER"S PERMIT � - 61232
N. 1280
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicate below at Z on the
C ,
side, betwe
at pemisesowned by G / rj
whose address is
and to Lay House Drain, Repair House Drain, Lay-Maim, Other
for
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( INDUSTRI L WAS . ), OR .( )
'�_
Connection will be made with—
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 HD Permit No. _
for street excavation.
SPECIAL CONDITIONS
l Signed�' LE►
Connection Charge Paid �/�� icensed Drain Layer
Issued by
Tax Collector / _
Permit Fee:. Paid $ _ `f, _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED `�, — (Date)
(Sig)
INSP CTOR
h.
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All r _
r
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777777
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14
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION /26 ovr> i7 r1r�
OWNER ko,6 es-
TYPE OF WORK ao a?,) ,
DATE ft/' - PERMIT 2 PIPE
INSTALLER
INSPECTOR DRAWN BY `~C-�