HomeMy WebLinkAboutDrain Layers Permit 88 Old Farm Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.: _
South Windsor, Connecticut -
List No.: _ 5
DRAIN LAYER'S PERMIT N? 2296
Md,)tt /" , 19 d�-11
Pursuant to written appl' atior, perm. sion is hereby granted to the Licensed Drain aver named herein to perform
the work indicated below at C on the
side, betw en /
at premises owned by G
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
Signed �-
�� -
Connection Charge Paid f,Im. Licensed Drain Layer
Q Issued by
Tax Collector ti
/ C f. �t
�ELCe Permit Fee: Paid $
INSPECTION: Check Number:
ID,tj
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
► V
J
as -►
off.r ck
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION L S / 04
OWNER So '. t-
TYPE OF WORK
DATE rl PERMIT L PIPE
INSTALLER r e o h s
INSPECTOR DRAWN BY C