HomeMy WebLinkAboutDrain Layers Permit 40 Nancy Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'_S PERMIT N? 2235
11117 , 19y
)4o nRicateif,
Pursuant to written app permission hereby granted to the Licensed Drain Layer named here'
y. in to perform
the work indicated below at on the
side, between
at premises owned by J'/ (0 s- =y7G
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
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
Signed
Connection Charge Paid L1D0 r Licensed Drain Layer
1 Y p' Tag Collector � 17 U v/permit ddIssued by Fee:. Paid $
INSPECTION: Check Number: a
INITIAL (Sig)C�o Vt-o s^
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
L
i ;-
I j
NOTES I SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER r=t 4--
{ j j 1 TYPE OF WORK ` S L ,.v c v1 7 -7,
1 r DATE "/ l° ca PERMIT Zd�3 PIPE
111 INSTALLER e) t)-0
INSPECTOR DRAWN BY