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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut,
List.No.: _
DRAIN LAYER'S PERMIT O 3376
19 el,
Pursuant to written applicatior, rmission is hereby
granted to the Li nsed Drain Layer named herein to perform
the work indicated below at on the
side, bet e
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
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.
SPECIAL CONDITIONS
Signed
Connection Charge Paid -z/00 Oy Licensed Drain Layer
L Issued by
Tax Collector
' Permit Fee: Paid $
INSPECTION: Check Number: �J O
INITIAL (Sig) _.
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR