HomeMy WebLinkAboutDrain Layers Permit 5 Old Farm Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2186
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at� Sr/5 &� on the
side, between
at premises owned by 1 CC?t° S
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 (, j, 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 Draig 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
_ Signea
Connection Charge Paid �U Licensed Drain Layer
Issued by
�/�• Tax Collector
U Permit Fee: Paid
INSPECTION: Check Number W-K _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)