HomeMy WebLinkAboutDrain Layers Permit 25 Oakland Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER"S PERMIT N? 1628
19
Pursuant to written applicatior, permission is hereby granted to the Lice n ed Drain Layer named herein to perform
the work indicated belo at 1z on the
l side, between
c +�
at premises owned by
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 ( ), INDUSTRIAL WASTES
�.( ), OR ( )
Connection will be made with
Permit to be issued to10�1��.Pv�� �T
.the holder of Drain Layer's License No. Permit will expire on 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
Signed
Connection Charge Paid S:_ Z4---Z�, Licensed Drain L er
Issued by 1,Zal—
Tax Collector
Permit Fee:. Paid $ 1�
INSPECTION: Check Number: .
INITIAL (Sig)
FINAL (Sig)
APPROVED — (Date)
(Sig)
INSPECTOPt
N
i
i'
l
1
_ r
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 2.5
OWNER
TYPE OF WORK f �-
0. , DATE •r- Q /' PERMIT `� PIPE � )
INSTALLER 2 -
�,�J// INSPECTOR DRAWN BY/-, �=