HomeMy WebLinkAboutDrain Layers Permit 75 Pine Knob Drive WN OF 1:0UTH WI N DS0r
1 .
y j DEPARTMENT OF; PQLjUTION CONTROL -
South WiJidsoi, Connecticut
` E DRAIN LAYER'S PERMIT
N•O
•.. 294
19 p
Pursuant to written application, permission.is hereby grantedto the Licensed Drain
Layer namedherein to perform
the work indicated below at 1� !^�,w Q {,[ (p / on the
{. side, between
at premises owned by fi�. �t z 1 j4 •
whose address is
;and to Lay House Drain, Repair House Drain, Lay Main, Other ,
for r=
occupancy or use,
with Family Units; with acres:
Type of Sewage to be connected under this permit:
SANITARY SEWAGE,j INDUSTRIAL- WASTES, OR
Connection`will be made with
r
Permit to be issued to ''
the holder of Drain Layer's License No. Permit will expire on. ..yx` 19 ^' .
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the per it and the teverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation:
SPECIAL CONDITIONS
Signed '`
Connection Charge Paid c,. Licensed Drain Layer -
(Sig) ` Issued by <' ,
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED a�aswi ' (Date)
(Sig)
INS ECTOR a-.
i
N
4',# .&1'
� 1Sf
77�
0
6
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION -7 ,ivc- K e L D k ,
OWNER At4ga&w
TYPE OF WORK Ser.�Ptt C ani,ale c
DATE 6 73 PERMIT Z ¢ PIPE
INSTALLER -::)', L a m c Q
INSPECTOR - -L DRAWN BY