HomeMy WebLinkAboutDrain Layers Permit 154 Pine Tree Lane TOW! OF S� H1�1 DS R
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EPAfiMIiNfi.'`OF F'OLLbT10N} 'NTROL
' South Windsor,:Connecticut
DRAIN LAYER' S PERM-IT 0 230
l l 19 .
Pursuant to,written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated'below at on the
side, between +
at premises owned by
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 ' AL
Permit to be issued to
the holder of Drain Layer's License No._ 4" Permit will expire on lg
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 AIM 40 SM
Signed f r'
Connection Charge PaidAMPP
Licensed Drain Layer
X go" (Sig) Issued by
Tax Collector
P it •. ai $
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED-J& UM 13 . (Date)
(Sig)
vft 8*0 INSP'lCTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION f S"q f 0f Y-re c 1.l e•e
OWNER
TYPE OF WORK
DATE PERMIT PIPE ,'
INSTALLER ! ,
INSPECTOR:)/- W< DRAWN BY f