HomeMy WebLinkAboutDrain Layers Permit 43 Paper Chase TOWN OF SOUTH WI N DSOR
" DEPARTMENT OF POLLUTION CONTROL Bhp No.: _
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 3516
19
1-3 pa po 4 ch ate. J
Pursuant to written appli atior, permi on is hereby ant1 _ ed to the Licensed Drain Layer named herein to-perform
the work indicated below at �� -- t�(!e—iLss
on the
side, between L at premises owned by %' Z
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 ( ), 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 /& C/
Connection Charge P 1$?Oed Drain Lafier
Issued by 'X�
lax Collector.
Permit Fee: Paid $
INSPECTION: Check Number: _
A
INITIAL (Sig) � y --
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR