HomeMy WebLinkAboutDrain Layers Permit 106 Orchard Hill Dri TOWN - OF . SOUTH WI N DSOR '�
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
List No.: _S-4O642-
DRAIN LAYER'S PERMIT NO 644
19
Pursuant to written appli��catior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at fo on the
side, between
at premises owned by ' t a" itas'r4 i ifs'•s..
whose address is
and to Lay House Drain, X Repair House Drain Lay Main, Other
for
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
V
SANITARY SEWAGE ( ' ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to AIL t. 4C.e n ..,.s
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 Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: -= Check Number:
INITIAL
(Sig)
4
FINAL (Sig)
APPROVED V' ;j7�t (Date)
..A x ;'c-4 (Sig)
r
INSPECTOR
r
N
�aa
STD
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER Ug
TYPE OF WORK
DATE PERMIT PIPE
INSTA
INSPECTOR DRAWN BY