HomeMy WebLinkAboutDrain Layers Permit 518 Pleasant Valley •; TOWN OF" SMTH WIN DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor,.Connecticut
DRAIN LAYER'S PERMIT 0 X601176
1
19 _
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at !�
on the
side, between 1ln. ti+.�ryg3 I
at premises owned by ---"
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:
t SANITARY SEWA =R.- INDUSTRIAL WASTES, OR
Connection will be made with �
.-Permit to be issued to Mm"I V146 miw+
the holder'of Drain Layer's License No. Permit will expire on M Now I
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 Paic S03-00" Licensed Drain yer
ftr Be
Tax Collector (Sig) Issued by Amm '
Permit Fee: Paid $ 1
INSPECTION: "1wirw.r.�rwr�
INITIAL (Sig)
FINAL (Sig)
APPROVED 06 "wr6ht 1 (Date)
INSPECTOR (Sig)
a FI f
fa 1-73
4/i
i
{ a