HomeMy WebLinkAboutDrain Layers Permit 524 Pleasant Valley *� TOWN OF- SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor; Connecticut
UA
DRAIN LAYER'S PERMIT XO 177
9
Pursuant to•written application, permission is hereby granted to the Licensed Drain Layer named herein to•perform
the work indicated below at , j on the
side, between X11" t w. am *80 -Drift,
at premises owned by �r.
whose address is 011, *
and to X Lay House Drain, Repair House Drain, _Lay Main Other
for occupancy or.µse,
with fJIM Family Units, with µchest
Type of Sewage to be connected under this permit:
� SAN IJARY sEwAc INDUSTRIAL WASTES,:QR
Connection will be made with NAW46" 04ow sm
Permit to be issued to- m 00r rawft s
SAM
4 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.sid
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
-SPECIAL CONDITIONS
Signed �' `" t* " a •�
Connection Charge Paid ""
$ N License Drain ayer
o" as R {
(Sig) Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: °w�nwwMww
INITIAL F, . . (Sig)
FINAL (Sig)
APPROVED (Date)
TOR (Sig)
INSP