HomeMy WebLinkAboutDrain Layers Permit 1103 Summer Hill Dri SOUTH .-WINDSOR
F POLLUTION NTROL
dsor,Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT M. 255
19
Pursuant to written applicatior, 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
whose address is
and to Lay House Drain, Repair House Drain, La Mai
Y n Other
for '
occupancy or use,
with Family Units, with
acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, 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 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. s
SPECIAL CONDITIONS
d
Connection Charge Paid Signed_ Licensed Drain Layer
Issued by
( T� Collector
Ct�
Permit Fee:. Paid $
INSPECTION: Check Number:
_ INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR