HomeMy WebLinkAboutDrain Layers Permit 485 Nevers Road TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
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List.No.: _
DRAIN LAYER'S PERMITp sgi
19t�i+p" 19
Pursuant to-written applicatior, permission,is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below..at 40 C,'4 S o2 3 on the
side, between,
at premises owned bye
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for . occupancy or use,
F. with Family Units, with acres.
Type of Sewage to be connected under thi$:permit:
SANITARY SEWAGE ( j, INDUSTRIAL'- WASTES .( ),-OR ( )
Connection will be made with ax
Permit to be issued to
the holder of Drain Layer's License No Permit will expire on 19
The undersigned Drain Layer hereb}t agrees to all the terms and'conditions set forth on the permit and t ereverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.`
SPECIAL CONDITIONS
v. Signed
Connection Charge Paid Licensed.Drain Layer
Issued by
.Tag Collector
Permit Fee: Paid $
INSPECTION: Check Number: 4'a
INITIAL (Sig)
FINAL '✓` (Sig)
APPROVED I (Date)
< (Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 4 77
OWNER ,•,
TYPE OF WORK
DATE la - PERMIT PIPE
INSTALLER u.-
INSPECTOR V DRAWN BY