HomeMy WebLinkAboutDrain Layers Permit 381 Pleasant Valley TOWN OF S1T W1 N DSOR
DEPARTMENT OF POLL' TION CONTROL gip No.: HAD?
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT KO 521
Jm. 29 ' 1974 '
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at y4 on the
side, be'tw'een
at premises owned by Aft' I"
whose address is
and to x 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 "M iA
the holder of Drain Layer's License N.o. Permit will expire on. 1 ' 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 ieense6d"Drain Layer
Issued b Af. 'iM3?d
Tag Collector -- Y
Permit Fee;. Paid $
INSPECTION: Check Number: ,
INITIAL :, `� ::1 . ,_ (Sig) .:
?.� FINAL (Sig)
APPROVED z... (Date)
« s9l
(Sig)
INSPECTOR
i
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION i ti F� is ✓'' :% ' Fr >��
OWNER
TYPE OF WORK —
DATE f PERMIT ) PIPE P
INSTALLER ,
INSPECTOR DRAWN BY