HomeMy WebLinkAboutDrain Layers Permit 82 Pine Knob Drive TOWN OF SOU. H WI N DSOR
DEPARTMENT 01 `POL°UTION CONTROL '
South Windsor, Connecticut
; ► DRAIN LAYER'S PERMIT O 98
.19:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer 4r med.herein to perform
the work indicated below at a on the
side,
at premises owned by
whose address is l
and to a� Lay House Drain, Repair House Drain, Lay Main, Other
for k M 92 .
occupancy or use,
with :0 Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE?' INDUSTRIAL WASTES, OR
Connection will be made with. gLaws`•
Permit to be issued to tiW& bum
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 Amu Uvw Ift s of%* at tmm 4" * '. tt
001,
f,z �
Signed��ri
Connection Charge Paid + ' / Licensed Drain Layer Y
(Sig) Issued by .
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED LA 04E (Date)
$_ S_.. 4& AA (Sig)
-° " I1fS'PECTOR
N
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ff,2- Pi'NP_ Kivo p R-_
OWNER
TYPE OF WORK
DATE 7- /l` PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY