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DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N° 2460
19
Pursuant to written applicatior, permission�iss hereby gr d to the License rain Layer named he to perform
the work indicated below at !7` C/
on the
side,:between
at premises owned
whose address is
and to Lay House Drain, Repair House Drain, 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
h the holder of Drain Layer's License No. Permit will expire on 19
The undersigned.Drain Layer hereby agrees to ali.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
02' Signed
Connection Char Paid('� /G Licensed Drain Layer
Issued by
ax Collector
Permit Fee:. Paid
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
--- APPROVED (Date)
(Sig)
INSPECTOR