HomeMy WebLinkAboutDrain Layers Permit 110 Pine Tree Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No..
DRAIN LAYER'S PERMIT Np 1625
19 l
Pursuant to written applicatior, permission is hereby granted to the Licen d Drain Layer named herein to perform
the work indicated below at - on the
side, betty en
at premises owned byaZ
whose addre is O
and to Lay House Drain, Repair House Drain, Lay-Main, Other ,
for —occupancy occupancy or use,
with _A- Family Units, with acres.
Type of Sewage to beco netted under this permit:_
SANITARY SEWAGE (� , INDUSTRIAL ASTES .( ), 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
�f C� Signed " W `'
Connection Charge Paid — / / Licensed Drain Layer
3& Issued by
tax Collector
Permit Fee:. Paid $ ��Q
INSPECTION• Check Number: z
INITIAL (Sig)
FINAL (Sig)
APPROVED 5 7q, (Date)
-xl z Z,�Zz (Sig)
INSPECTOR
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a� `PO 5
N zX/s,7/"ic� P
16
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1.
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a. f J
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 116 /i 11V6 L /�
OWNER Z, l/`
TYPE OF WORK .fie we- A
DATE PERMIT PIPE
INSTALLER -11 J
INSPECTOR DRAWN BY '�