HomeMy WebLinkAboutDrain Layers Permit 179 Norton Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: .
DRAIN LAYER'S PERMIT NO i595
, 19 -7 9 _
Pursuant to written applicatior, permission is hereby granted to the Lictnsed Drain Layer named herein to perform
the work indicated below at
on the
1" 0 e,h side, between
at premises owned by_Eg M
�o � L
whose address is
and to �ay House Drain, _Repair House Drain, Lay-Main, Other
for QpK _occupancy or use,
with od-a j g Family Units, with acres.
Type of Sewage to be connected under this permit: :a� r��T,c�
SANITARY SEWAGE ( �1N OR
DUSTRIAL WASTES _ v
( ) ( )
Connection will be made with �� r
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 Licensed Drain Layer,
7
Issued by
Tax Collector
Permit Fee Paid $ C�
INSPECTION: Check Number: ��
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)