HomeMy WebLinkAboutDrain Layers Permit Lot 50 Norton Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
- South Windsor, Connecticut B/P No.:
List.No.: _�O
DRAIN LAYER'S PERMIT NO 1671
N�
J u 1 y , 19�_
Pursuant to written applicator, permission is hereby granted to they Licensed Drain Layer named herein to"perform
the work indicated below at 0 on the
side, between
at premises-owned by—
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, j Other
for occupancy or use,
with � 3Z Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (✓), INDUSTRIAL WASTES _( ), OR ( )
Connection will be made with
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
All Signed
Connection Charge Paid Z /f.Z q Licensed Drain Layer
Issued by �
Tax Collector
00
Permit Fee: Paid
INSPECTION: Check Number: ���
INITIAL (Sig)
FINAL (Sig)
APPROVED _ZX (Date)
INSPECT (Sig)
OR
a
v
11
VC.
c�
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER�. T
TYPE OF WORK
DATE PERMIT f PIPE ri
INSLALLIM
INSPECTO RAWN BY