HomeMy WebLinkAboutDrain Layers Permit 63 Old Farm Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 21-55 ..
, 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 1�
/v—� - �`' on the
side,, between
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
f
_ - Permit to be issued'to'
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer*reby.agrees to all the terms and conditions set forth on the permit and the ieverse side
: thereof. Applicant has received Town Permit No. and/or C H-D Permit No.
for street excavation.
SPECIAL CONDITIONS
A
Signed
Connect' rge Paid WJV Licensed Drain Layer
Issued by
Tax Collector
dZ
Permit Fee:. Paid $ �._ ,
INSPECTION: Check Number: C �
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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