HomeMy WebLinkAboutDrain Layers Permit 268 Oak Street TO OF SO10 H* WINDSOR
-�- DEPARTMENT OF POLLUI �N CONTROL
South Windsor, Connecticut
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DRAIN LAYER'S PERMITO
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ?'_�
/f� on the
A/6r rl side, between { >:' A/V D
at.premises owned by j sj#-� 4 9 it �"I K
whose address is •� _ •y .
and to Lay House Drain, Repair House Drain, Lay Main, Other
for 1 v 3 /k'� it'd�
occupancy or use,
with J {jNt'. Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE INDUSTRIAL WASTES,:OR:,
Connection will be made with � /e
t3 4^ 71',G------------
y>r p
ermit to be issued to C. .
the holder of Drain Layer's License No. Permit will expire on r
P• �Ll ti ,/ '� �. 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the perm and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation. '
SPECIAL CONDITIONS
Signed -`-.- ' ' �r •' f �..�,,,,,�,,,..,.�,
Connection Charge Paid $ Licensed Drain Layer
(Sig) issued by ) t 3
Tax Collector
Permit Fee: Paid $_
INSPECTION:
INITIAL
FINAL (Sig)
APPROVED ;.&IAc c�73 (Date)
(Sig)
JINSPECTOR
1.
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NOTESSOUTH WINDSOR POLLUTION CONTROL
LOCATION ;� 6 0,4 K" S7;
OWNER
TYPE OF WORK
DATE 6 2 PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY