HomeMy WebLinkAboutDrain Layers Permit 190 Orchard Hill Dri (2) } TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT Na 768
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at '' 1 /9d i ?A_ )ri 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
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 tt-IS- -74 Licensed Drain Layer
nn N
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED 1 Z- 20`- 74 (Date)
ri 5 (Sig)
INSPECTOR
�O
N
a,
NO SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE - PERMIT G PIPE
INSTALUR
INSPECTOR DRAWN BY