HomeMy WebLinkAboutDrain Layers Permit Nutmeg Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT NO 2596
C, , 19
Pursuant to written applic tior, ermis ion is her granted to the Licensed Drain Layer named herein to perform
the work indicated below at �J S L
on the
side, b4lworej
at premises-owned b 0 L
whose address is
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 ( ), 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
�v 1
onnecton Charge"Paid? f�'Z Signed Licensed Drain Layer
Issued by
e or
�r
Permit Fee:. Paid
INSPECTION: Check Number: l _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)