HomeMy WebLinkAboutDrain Layers Permit 27 Oak Street rt TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2415
42- , 19 cif
Pursuant to written applicatior, permiss on is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at4 oC4 _ on the
side, between
at premises owned
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 { j, 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 a 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
4-1
cf �a
4
Signed
Connection Charge Paid 'to 0 - 6 O Licensed Drain Layer
s
��rc �2dixli Issued by
lilyTax Collector
Permit Fee: Paid $
INSPECTION: Check Number: �a�
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
SJvv701
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