HomeMy WebLinkAboutDrain Layers Permit 72 Pleasant Valley R TOWN OF SOUTH WI N DSOR
/ DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN LAYER'S PERMITO 3
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named,-herein to perform
the work indicated below at on the
tt side, between 44 _ g ' +a r i
Aft
at premises owned
whose address is jw1u,4001A-ifffif
.
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 withi
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:R D Permit No.
for street excavation. -
SPECIAL CONDITIONS
Signed
Connection Charge Paid. $ Licensed Drain Layer
(Sig) Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED #, #4 rp*o (Date)
(Sig)
INSPECTOR