HomeMy WebLinkAboutDrain Layers Permit 53 Pine Knob Drive TOWNOF SOUTH WI N DSOR
DEPAR-.TMENT OF POLLUTION CONTROL
South Windsor, Connecticut
N
DRAIN LAYER'S PERMIT 4 297
} r , 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at `x +. p.. ` ''w: on the
r 4 side, between
at premises owned by 4,", , I
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with r+r. • Family Units, with acres.
r
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 jv 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the per'it and the reverse side .
thereof. Applicant has received Town Permit No. apd/or C.H D,Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed 4r �-" s r
Connection Charge Paid $ '.,4.. ,v f Licensed Drain Layer
(Sig) Issued by
Tax Collector
Permit Fee: Paid
INSPECTION:
INITIAL _ .. . (Sig)
FINAL (Sig)
APPROVED (Date)
s
(Sig)
I1fTSPECTOR
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N
76
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION A G 1 b �
OWNER 4 /aW
TYPE OF WORKS
DATE G 4 A, ' PERMIT PIPE 6`
INSTALLER' L-ef rf .
INSPECTOR 'Y�-1_ DRAWN BY