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HomeMy WebLinkAboutDrain Layers Permit 200 Oak Street (2) F TOWN S , Rr ."H WIN DSOR �. 4r DEPARTMENT OF PI99LU.TION CONTROL South Winds; Connecticut © F, DRAIN•, LAYER'S' PERMITA. _ 'S.2 Pursuant io.written application, permission is hereby granted to the Licensed Drain Layer named herein to perform € the work indicated below at f ► *f ` on the Sid n oO at premises owned ................................, { a whose address is and to t; Lay House Drain, Repair House Drain, Lay Main, Other , for 4 occupancy or use, x with' Family Units, with-,- acres. 41 Type of Sewage to be connected under this permit: SANITARY SEWAG , INDUSTRIAL WASTES, OR Connection will be made with E 3 Permit to be issued to a , the holder of Drain Layer's License No. Permit will expire on/j'.. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the pefinit add the reverse side thereof. Applicant has received Town Permit No. and/or C H D Permit No. ' for street excavation. . ,t SPECIAL CONDITIONS_'' , t; s k k Signed _.. Connection Charge Paid $ Licensed Drain Layer 3 ` l ' (Sig) Issued by Tag Collector Permit Fee: Paid $ . INSPECTION: ^ INITIAL (Sig) -...,..". y FINAL (Sig) *. T'- APPROVED (Date) '- ' (Sig) r.. INSPECTOR