HomeMy WebLinkAboutDrain Layers Permit 195 Orchard Hill Dri (2) 7
TOWN 0 SOUTH -WINDSOR
+ DEPARTMENT, OF POLLUTION CONTROL
B/P No.:
SouthlWindsor, Connecticut
List.No.
f. DRAIN LAYER'S PERMIT
N° ,fi' 1 "
Pursuant to written application, permission is hereby.granted to the Licensed Drain Layer naned herein to:perform
J` the work indicated below,at ou !6 _ on the
side,-be I tWeen
at premises owned
whose address is
and to Lay;House Drain,' Repair House.Drain, l;a�Matn, or
forsmoccupancy or use,
with family Units, watt} awes.
` Type of Sewage to be connected under this permit:
SANITARY SEWAGE, 'j, I1VllU$TRTAL WASTES
Connection will be made with
' (► • .
'• ` Permit to be issued.to -
the holder of Drain Layer's License No. Permit}will expire on
19 .,
The undersigned brain Layer hereby agrees to a'll the terms and,conditions set forth on the permit and-the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No. ,
for street excavations
SPECIAL CONDITIONS
Signed `
Connection Char�e Paid Licensed Drain Layer
+ Issued by
Tag Collector
Permit Fee:. Paid'$ _
INSPECTION: Check Number: ,
INITIAL q 'it', is came +sue09AI S (Sig)
FINAL S (Sig) '
h
APPROVED—►.Jig 0--ja ++t f'7+1A- (Date)
(Sig)
INSPECT
6