HomeMy WebLinkAboutDrain Layers Permit 455 Nevers Road 771
TOWN TH '
; - r 0 N OF. .S�� WI NDSOR .
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
, List.No.: �•�Sb�3--
DRAIN LAYER'S PERMITp 63 .
, 19
Pursuant to written applicatior, permission is`hereby granted tor the Licensed Drain Layer named herein to perform
the work indicated below at ZO on the
side, between_ r '
at premises owned by
whose address is
low
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 ( j, INDUSTRIAL WASTES;
Connection will be made witht ,+ _ t
,r
Permit to be issued to-
the holder of Drain a er's License No. Permit will expire on 19
Y P
The undersigned Drain Layer hereby agrees to all the terms and'conditions.set forth on the pe'tmit and,-the re*erse side
thereof. Applicant has received Town Pet'mit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid lleensre&Drain Layer. -
Issued by + #
Tax Collector
Permit Fee:. Paid $
INSPECTION• Check Number: ,
INITIAL (Sig)
FINAL (Sig)
APPROVED _-9/ ,�, (Date)
(Sig)
ECTOR
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