HomeMy WebLinkAboutDrain Layers Permit 411 Nevers Road WN:,, OF SOUTH WI N DSOR
DEPARTMENT OF ROLLCUTION .Cbwia ._ 4`
B/P No.:
South'Windsor, Cognga.ticut -
�. List.No.:
DRAIN LA'YER'S"!PERMIT O 684
19
Pursuant to,written applicatior, permission,is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ' � � .. . on the
1 side 't 1201ft DNA +
at premises owned by ,��•.
whose address is—
and to . Lay House Drain, .. Repair House Drain, Lay-Main, Other
for 1 occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit: r
SANITARY SEWAGE (9), INDUSTRIAL WASTES .( );0R ( j
Connection will be made with
Permit to be issued to, a
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
z
Signed f
Connection Charge Paid 7Lioens:ed Drain Layer
Issued bqAIM
Tax Collector
- Permit Fee:. Paid $ _
INSPECTION: Check:Number:
INITIAL (Sig)
t FINAL (Sig)
APPROVED Vil l l .i° (Date)
(Sig)
INSPECTOR
r
I
A
oel
NO SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTAL "
INSPECTO DRAWN BY