HomeMy WebLinkAboutDrain Layers Permit 63 Palmer Drive TOWN OF SOUTH WINDSOIR
" DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _ ..
DRAIN LAYER'S PERMIT
p 7
42
19
Pursuant to written-applicatior, permission is hereb granted to the Licensed Drain Layer named herein to-perform
the work indicated below at on the
side,,between
at premises owned by
whose address is
and to i Lay House Drain, Repair House Drain, Lay Main, Other
for
occupancy or use,
with - Family Unita, with acres,
Type of Sewage Go be connected under this permit:
SANITARY SEWAGE j, INDUSTRIAL WASTES -( ), OR ( )
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 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
e xre it _
Connection Charge Paid Licensed ram Layer
Issued by �e
Tax Collector :
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECfiOR (Sig)
N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER f
TYPE QV WORK
DATE PERMIT PIPE
INSTALLER ;
INSPECTOR DRAWN BY