HomeMy WebLinkAboutDrain Layers Permit Maple Ridge Sub - Or .. -v 1'OW OF St U� WI DS R ;
-.
` ' DE I'AItTMFNT OF Pp L bN_.CQNTROL B/P No::
• - � south:Windsor, Gx�`nn�ctieut
- List.No.. _
DR'AI,N 'LAYtWS :PERMSIT tTp 54
r ��l
- as , 19
Pursuant co written atppU'atior 'permission is hereby gr�aynted io`the Licensed Drain Layer named herein to perform
the work indicated below, at on the '
side, between__
at premises owned by
S - -
- whose address is
and to Lay House Drain, Repair House Drain, Lay Main; Other
for F
occupancy or use,
with F.milyr.Um�.ts,witdi�; k acre. x
Type.pf Sewage•to be connected`pnder�thia,permit
SANITARY SF WAGE ( j YNbLfSTRTAL t A3'F'ES (' ') OR ( r Y
'Co ection ill be made with w>
' rA.
Permit`to be issued to AMOK
36r A04
P
the holder of Drain.LAyer's �.icense No Permit pulls pine on
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the retie{se side
s, thereof. Applicant has received Town Permit No. and/or G H D Permit No.
for-"street excavation.'
s ► two ' 1 *' ,
SPECIAL-CONDITIONS
AW
JI
Signed
_ Connection Charge Paid t a, L' ns'ed Drain yer
v Issued by-� Y` y
Tax Collector ;_- •.
Permit Fee:. Paid $ _
r INSPECTION: Check Number
INITIAL (Sig)
FINAL _ (Sig)-
00
APPROVED �+'
(Date)
(Sig)
INSPECTOR
C