HomeMy WebLinkAboutDrain Layers Permit 5 Nancy Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT 10 2334
Pursuant to wr 5Ap41i o ssin�hereby ranted to the Licensed Drain Layer named herein to perform
-` 1
the work indicated below'at � on the
side, between
at premises owned by__ `- xY7 _
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 tvi11,be made with
Permit,to be issued to
the holder of Drain Layer's License No.,_ Permit will expire on 79
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 16,,116 D U Licensed Drain Layer
�^A i o 1��C n�ir�v� Issued by
Tax Collect r
7Ll'/U � Permit Fee:. Paid $
INSPECTION: Check Number: �1
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSP9ET.OR (Sig)
- r� �
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NOTES SOUTH 14INDSOR POLLUTION CoNr L _
LOCATION e c, .% "! N �
OWNER S ,
TYPE Or WORK S
DATE PERMIT PIPE
INSTALLER :
INSPECTOR DRAWN BY