HomeMy WebLinkAboutDrain Layers Permit 190 Palmer Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL '
B/cR No,:,
South Windsor,Connecticut
- List No.: "
DRAIN LAYER'S PERMIT T? 769
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �/
on the
side, between-
SMat premises owned by J•"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 j, INDUSTRIAL WASTES ), OR
Connection will be made with
Permit to be issued
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 Charges Paid'
Licensed Drain Layer
Issued by
Tak Collector r`
Permit Fee:..Pai
INSPECTION: Check Number: = —
INITIAL t
(Sig)
FINAL °�"
(Sig) "•
APPROVED �j0 (Date)
(Sig)
INSPECTOR
i
9 .�c i
1,
uj
/ n
1
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER r= .
TYPE OF WORK
DATE PERMIT PIPE
INSTALLE R ,
INSPECTOR DRAWN BY