HomeMy WebLinkAboutDrain Layers Permit 186 Pine Tree Lane TOWN - OF SOUS H Wl D R
Ll� , ta two# DEPARTMENT OV -M, UTION CONTROL
South Windsor, Connecticut
ftoe
DRAIN LAYER'S PERMIT O 336
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
u5
- ° side, betweeri_ ilf
at premises owned
whose address is bi"1
and to Lay House Drain, Repair House Drain, - Lay Main, Other ,
for occupancy.or use, .
with aw W Family Units, with acres...
Type of Sewage to be connected under this permit:
SANITARY SEWAGE] INDUSTRIAL WASTES, OR
Connection will be made with. '
3
Permit to be issued to__ Aft it IM
� y
the holder of Drain Layer's License No. Permit will ex0ire on 19 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the hermit and-tho�reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No. "
for street excavation.
SPECIAL CONDITIONS " eat
'tobs
Signed
Connection Charge Paid ++ + icensed rain Lafer
(Sig) Issued by s J01
Tag Collector
Permit Fee: Paid $'�
INSPECTION: M
- INITIAL: (Sig) y
FINAL (Sig) y,
APPROVED . (Date) 4
3 (Sig)
INSPILFC T OR
N
reY1i.Z.l cs
0
a
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ,�F is
0 OWNER ` ,a
TYPE OF WORK .,s!
A �Z- DATE 2,----71 PERMIT PIPES" 477.
INSTALLER L A�-k E.11 J,I (�� n
INSPECTOR DRAWN BYE__.. _--