HomeMy WebLinkAboutDrain Layers Permit 177 Pine Knob Drive TOWN E UTH�� WI IDSOR
DEPARTMENT O POLLUTION CONTROL
4*Jr "� Soyth:Windsor,.Connecticut
Sao 0r*1
DRAIN LAYER'S PERMIT `O 21
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Ift am am& SAV111on the
side"
M NYi
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain,, Lay fain, Other
fora1 occupancy or use;
with i! Family Units, with acres.
Type of Sewage to be connected under this permit;..
:''SANITARY SEWAGE) INDUSTRIAL WASTES,.OR
Connection will be made with
a► i::
Permit to be issued to logo" 24 am
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 reve.{se side
thereof'L Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation-.
SPECIAL CONDITIONS i ; "*a ►
Signed ._
Connection Charge Paid Licensed Drain Layer
(Sig) Issued by WWAft' Oto
Tax Collector
P mit F s� Paid $
INSPECTION:
Of
INITIAL (Sig)
FINAL W (Sig)
APPROVED * (Date) .`
It *W"W lot (Sig)
INSPECTOR