HomeMy WebLinkAboutDrain Layers Permit 47 Old Farm Road TOWN Q�y SOUTH
TO° WIN:t �QR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut .
List No.:
DRAIN LAYER ,S ,PERMITO
Pursuant to written,applicatior, permission is hereby granted to th Lic nsed Drain Layer named herein to perform
the work indicated below at �-T •( • on the
Side, between
a e
at premises owned by
whose address is
and to Lay'House Drain,' Repair House Drain, Lay, Main, _rOther '
for occupancy,or use,
with Family Units, with acres::
Type of Sewage to be connected under this permit:
SANITARY SWAGE (; ), INDUSTRIAL WASTE$ ;( ); QR ( ) —
Connection will be made with
f r, .�. {
-
ti t Permit to b�.issued to ,
4, the holder of Drain Laygr',s License No. Permit will expire on B
• The undersigned Dcam,Layer hereby agrees to all the Berms and 'conditions set forth on the"perm,it an the ieverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No:
for street excavatign. ;
SPECfAL COND-ITIONS r. .
'�
/9/9 Signed
Connection Charge"Paid d a do. Licensed Drain Layer
Qu" Issued b
Tax Collector
y
Permit Fee:. Paid $
INSPECTION: Check Number: �.1Fd1
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date) of _
(Sig)
.INSPECTOR
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DOTES SOUTH 14INDSOR POLLt3TI0N C0� ROL
LOCATION C1r�s e
OWNER 5e;�
TYPE OF WORK
DATE - /0- ! PERMIT 2 7rIPE �' ✓�
INSTALLER **i.*S f"a
INSPECTOR S C- DRAWN BY <