HomeMy WebLinkAboutDrain Layers Permit 84 Pine Tree Lane (2) :S m TOWN OF UTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
' South Wirl sor,Connecticut
DRAIN LAYtR'S PERMIT ` NO 308
19
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between•.
at premises owned b;�SOt% 0
whose address is
and to < ' Lay House Drain, Repair House Drain, Lay Main, Other ,
for ,._ ;.. ` occupancy or use,
with _1 ; - Family Units, with acres.
Type of Sewa a to be connected under this permit:
SANITARY SEWAGE INDUSTRIAL WASTES, OR
Connection will be made with r fr +
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 per#f and the reverse side
y thereof. Appkicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
T
SPECIAL CONDITIONS �' s x r,
Signed
Connection Charge Paid $ Licensed Drain Layer
' r (Sig) .issued by ,
Tax Collector
Permit Fee: Paid'.$:. ,
INSPECTION: 4
_. . INITIAL (Sig)
FINAL (Sig)
APPROVED .# (Date)
Oct. S!r * !". (Sig)
INSPECTOR
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