HomeMy WebLinkAboutDrain Layers Permit 200 Oak Street -- TOWN _ F sb TH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Winds gt, Connecticut40
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' '` DRAIN LAYER ' S` PERMIT ," O 262
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated belowat % .4d ;, a? J': :%• on the
/R/c!r.f �► 5i sid 4* n j :.x'"' `'.0 t: :
at premises owned by 4j s{rs VPI,/
whose address is "�
and to Ul Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with `AJ -' Family Units, with- acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAG) INDUSTRIAL WASTES, OR
r Al � �{
Connection will be made with1d s'o < <
Permit to be issued to �}
the holder of Drain Layer's License No. Permit will expire on//-,-f
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the pedmit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for.street excavation.
SPECIAL CONDITIONS ?� I.1 r� _ ,.i Y d' ' r:�}, ,,� r •. � .✓b�►
Signed 01
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Connection Charge Paid Licensed Drain Layer
f: a:" 4 , £ ' ' •'�; (Sig) issued by
Tax Collector
Permit Fee: Paid $1.r
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR