HomeMy WebLinkAboutDrain Layers Permit 162 Palmer Drive s
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF' POLLUTION-^C,ONTROL
B/P No.: . �
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT`
No 682
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to p
the work indicated below at__' '_
side, between
at remises owned b°
1? _
v
whose address is
and to _Lay House Drain, Repair House Drain, Lay-Main, Other
for i(!'Ir occupzncy or use,
-with the Family Units,'wiih acres.
Type of Sewage to be,connected under this permit:
SANITARY SEWAGE ( , INDUSTRIAL WASTES :( ), OR (` )
Connection will be made with #W sua AA #
Permii,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.aiu t e reverse.side
thereof. Applicagt has received Town Permit No. and/or C H D.Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid + Licensed Drain Layer
Aimot" ** Issued by ha Z if f Jam,
Tax Collector
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL ' iw (Sig)
;Q . 1440 FINAL (Sig)
APPROVED l (Date)
PECTOR
(Sig)
N
G.S°
13,o' F Zzo
H `
i
D
3a.s
NOTES SOUTH WINDSOR POLLUTION CONTROL
,Vl LOCATION is,2. ,,Ea p sa
OWNER Roeeu.•r L U , c.
TYPE OF WORK S,,,6e L'_ N^ ,a �.dc-rl
,q Z9.� DATE PERMIT 682. PIPES
INSTALLER o,a, v1 q-.2o4ssq)
INSPECTOR DRAWN BY <4—