HomeMy WebLinkAboutDrain Layers Permit 210 Pine Tree Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER"S PERMIT N4 1186
'rah �✓ Z , 19
Pursuant to written applicatior, permiss' n is hereby grante to the Licensed Drain Layer named herein to perform
e
the work
indicat below at � Z,IC ii /kx on the
e�T side, between 0 A 9° d e I G
at premises owned by
whose address is
z/6
and to Lay House Dr in, Rep it House Drain, Lay Main, Other ,
�'� Gl for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( INDUS AL W TES , OR
,
/1 Q
Connection will be made with Y
Lot
Permit to be issued to C16 t -e—-✓ Ca ;5;` ,� �'
ar r-C_
the holder of Drain Layer's License No. ZO 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 a r
Issued by
Tax Collector
Permit Fee Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL r' C /" �' / - (Sig)
APPROVED (Date)
�Gls``�<w ;t,��-..... (Sig)
INSPECTOR
N
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r,
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION e' k'
OWNER
TYPE OF WORK rr:`c' " ; A ;•
DATE / PERMIT ftlldg PIPE f/—1111,
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INSTALLER 1 e`
INSPECTOR 7'?'' DRAWN BY f'