HomeMy WebLinkAboutDrain Layers Permit 1305 Summer Hill Dri j t TOWN". F SOUTH WI N DSOR
DEPARTME OF POLLUTION CONTROL
B/P o :
South �lindsor, Connecticut
Lists No.: _
DRAIN LAYER'S PERMIT
O
•
' 19 �3
Pursuant to written applicatior, perm' lion is hereby gra/nte to the icensed Drain Layer named herein to perform
the work indicated below at 13 e� on the
side, betwegn
at premises owned by
whose address is
and to Lay House Drain, Repair House 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
Permit to be issued to
the.holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layerahereby 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
Conn n Charge Paid U,& �,3 Licensed Drain Layer
Issued:by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL
(Sig)
_ FINAL (Sig) -
APPROVED (Date)
INSPECTOR (Sig)