HomeMy WebLinkAboutDrain Layers Permit 51 Pleasant Valley R 1
TOWN OF SOUTH �WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
"South Windsor, Connecticut B/P No.:
List No.:
DRAIN LAYER'S PERMIT NO 901
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at a r 1 ,"j'^`o'="a on the
side, between
w..
at premises owned by_
whose address is -96MC
and to X Lay House Drain, Repair House Drain, Lay Main, Other
for
occupancy or use,
with '�I�tE Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with iiXi.: .i.:ti:.]t; ;4,
Permit to be issued to Jack Iwo
the holder of Drain Layer's License No.W—�i 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 €Z Licensed Drain Layer
Issued by �y.�,:i.. c • :+:«�.L,e
Tax Collector
Permit Fee: Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
t
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a'
jl*
f I,
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER c, J
TYPE OF WORK 1 /-
DATE '' : '- PERMIT 5W PIP
- INSTALLER � E
INSPECTORE -Ld DRAWN BY -�