HomeMy WebLinkAboutDrain Layers Permit 65400276 ~� TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN LAYER ' S PERMIT NO
255
-C, i 19 r
Pursuant to written application, permission is hereby granted to the Licensed Drainl Layer named herein to perform
the work indicated below at �a / ` °� �/ on the
side, between /// e,.
at b R ' + fa t t c.: 7 � 13 c remises owned , f
p y r :.t
whose address is
and toF Lay House Drain, Repair House Drain, Lay Main, Other
for l` >:- f .{: ': 7, !i I
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
(ANITARY SEWAGE INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be issued to ; rt"i (,: /,•<.N
the holder of Drain Layer's License No. Permit will expire on s/a 19 2
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permi and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS ,�:•, ry .. > r ., ;. + �
Signed Ft,yy► � �°"t1.
Connection Charge Paid,A ; 4,. ' Licensed Drain Layer
(Sig) issued by , ,!
Tax Collector
Permit Fee: Paid $ f ,� ¢p
+
INSPECTION: �` M*CIA
INITIAL (Sig)
FINAL (Sig)
APPROVED J t) (Date)
(Sig)
INSPECTOR
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�jv.io 've c e.v Y�l f. i�•�r�c}e-d A., 44 cic.Y
c� d A..v,r 6 Yv h"�.v c�u a-ri�►jr �/r c.�,v,a��a,..� ,��-c.r e-v r
y v 4Le JifQ�'�L�,A
/4 f r t -74o Ac'�e I `
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 2 p
OWNER
TYPE OF WORK
DATE iS PERMIT PIPE 6 a
INSTALLER
INSPECTOR DRAWN BY