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HomeMy WebLinkAboutDrain Layers Permit 230 Orchard Hill Dri N TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL B/P No.: a's South Windsor, Connecticut f. List No.: _ DRAIN LAYER'S PERMIT N? 766 013, 119 24 Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform ALB 'L� the work indicated below at_ T` ©mCht"-d M-11 Drive on the side, between at premises owned byae whose address is and to X 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 (X), INDUSTRIAL WASTES ( ), OR ( ) Connection will be made with Six zKo rR3-rt4 a pus Permit to be issued toJ�H�t-x+.— y#; the holder of Drain Layer's License No. W. 20%03!5 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 Jw /` Signed Connection Charge Paid Lic ns Drain"Layer Issued by .—BM4 th Tax Collector Permit Fee: Paid $ _ -J%.00 INSPECTION: Check Number: INITIAL fzA (Sig) FINAL � ,uz (Sig) APPROVED Uzi (Date) (Sig) -S C 0R N NOTES SOUTH WIND OR POLLUTION CONTROL LOCATION OWNER TYPE OF WO DATE PERMIT PIPE INSTALLER INSPECTOR DRAWN BY