HomeMy WebLinkAboutDrain Layers Permit 16 Old Farm Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut ��j-Z Z
List No.: _
DRAIN LAYER'S PERMIT N? 2192
� y 119JO
Pursuant to written applicatior, permission isl hereby
/fgranted
jto the Licensed Drain Layer named herein to perform
the work indicated below at L�D� 3 / '�� l//C' �"�1/'YYI eG on the
side, between 1
at premises owned by Uu �' �t i° S` 1riC
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 to
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
? 90
W 1770 1� _ Signed
Connection Charge Paid YD� Licensed Drain Layer
Issued by
Tax Collector IM
Fee: Paid
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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