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HomeMy WebLinkAboutDrain Layers Permit 160 Pine Knob Drive -- TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL B/P No.: South Windsor, Connecticut List No.: DRAIN LAYER'S PERMIT p 1408 T AIO cf3 , 19 *7A— Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at 4i © P/NC- X/V b$ Pgj YE-- on the side, between at premises owned by whose address is 6 4"16- and to Lay House Drain, Repair House Drain, Lay-Main, Other , for RU5 4 De-IV-7-JAL, occupancy or use, with l Family Units, with acres. Type of Sewage to be connected under this permit: SANITARY SEWAGE (�, INDUSTRIAL WASTES .( ), OR ( ) Connection will be made with Permit to be issued to CQAh-179t(C:nQA/ TNC,, 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 Signed Connection Charge Paid Licensed Drain Layer lU- Issued by Tax Collector Permit Fee:. Paid $ INSPECTION: Check Number: S INITIAL (Sig) FINAL (Sig) APPROVED `� ~ (Date) -A (Sig) INSPECTOR7" I r 4.5 ° I I5° � --� 35/ I i \ 1 / J 4.5 \I f i I I i i NOTES SOUTH WINDSOR POLLUTION CONTROL LOCATION OWNER L 0\1 TYPE OF WORK DATE PERMIT PIPE INSTALLER INSPECTOR DRAWN BY