HomeMy WebLinkAboutDrain Layers Permit 123 Pierce Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
Li
South Windsor, Connecticut st.No.: _�16 i7Y/�—.
DRAIN LAYER',S PERMIT NO 1807
d 19
Pursuant to written applicatiorrr�, permission is bereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at I of m- rG r �- I on the
side, between
at premises owned by—
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 withC--
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
40yev, oo
Signed �.
Connection Charge Paid /�� Licensed Drain Layer
Issued by
Tax Collector y
Permit Fee:. Paid $
_—X 3 75—
INSPECTION: Check Number: /,
INITIAL (Sig)
FINAL (Sig)
APPRO ED (Date)
(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION / - a c
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY
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