HomeMy WebLinkAboutDrain Layers Permit 124 Pine Tree Lane TOWN OF SOU A,WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, C�nnecticut
LIST
x DRAIN LAYER'S PERMIT
O 250
19
Pursuant to-written application, permission is hereby grantedto the Licensed Drain Layer named herein to perform
the work indicated below at 12-41 Al AJC Tree L Q r, on the
side,,between
at premises owned by EJh/ bVy 6"d
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use,
with 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
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
(Sig) Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
,FjNA L (Sig)
A OVED o s .L,j A, 197 3 (Date)
(Sig)
INSPECTOR
I
N
1
r
J
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER C,'L kt- L n Sri
TYPE OF WORK . r. t't r+' .< ••4. ,.,r .
DATE ex ;• 'Er PERMIT PIPEc.'`
INSTALLER
INSPECTOR - DRAWN BY