HomeMy WebLinkAboutDrain Layers Permit 112 Pine Knob Drive •-Xft
OWN OF SOUTH WtNDSOR
DEPARTMENT OF..POLLUTION CONTi OX
t`: q South Windsor, Connecticut
' DRAIN LAYER'S PERMIT
O 296
!, 9" 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at
jj —=r ----_-. s � on the
side, between
at premises owned by
whose address is
and to ' Lay House Drain Repair House Drain, Lay Main, Other
r r.
for r x: ;
occupancy or use,
' with - 00 Family Units, with acres.
Type of Sewage to be conneted u)er this permit:
F. SANITARY SEWAG4 INDUSTRIAL WASTES, OR
Connection will be made with 3 It •
� Q
i, Permit to be issued t
the holder of Drain Laydr's I,i`i en No. Permit will expire on, 19 .
The undersigned Drain Ltayet reby agrees to all the terms and conditions set forth on the peei�'$-scid the reverse side`
thereof. Applica't has reboix8d Town Permit No. and/or C H D Permit No.
for street excava 'on:
SPECIAL ONDITIONS
Signed f,
Connection Charge Paid $. - — Licensed Drain Layer j
Tag Collector (Sig) Issued by
Permit Fee: Paid'` W
s sue,.,, I-Mha" '�"°'
INSPECTION:
INITIALY- (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
~ INSPECTOR