HomeMy WebLinkAboutDrain Layers Permit 612 Pleasant Valley TOWN OF SOUTH WIN DSO
q. R
QEPARTMENT O.F POLLUTION CONTROL
South windsoi, Connecticut B/P No.:
List.No _ -3 '
DRAM LAYER'S PE:R_MIT 0,51 �
594
19
Pursuant to written applcatior, permission is hereby granted to the Licensed Drain Layer.named herein to perform
the work indicated below at _ , t .
on the
`side, between �t
arpremises owned by
whose address is
and to ULay House Drain, Repair House Drain, La
y:Maih; Other
for ,
occupancy or use,
with Family Units, with.
acres.
Type of Sewage to be connected under this permit:
---------------
SANITARY'SEWAGE j, INDUSTRIAL WASTES _( ), O ( '
Connection will.be made:with
Permit to be issued to ° . L
the holder of Drain Layer'q License No. MVIOMMIM
Permit will expire on .
The undersigned Drain Layer Hereby agrees to all the terms and conditions set forth on the permit and the reverse s9de
thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Signed
Connection Charge Paid • icensed Drain Layer
SMMk� IL
Tax Collector
Issued,by '� .
Permit Fee:L Paid $
r INSPECTION: Check Number;
INITIAL iil�� f o d11Adt (Sig)
FINAL }r `t - ►s _ f (Sig)
APPROVED (Date)(Si '
' B)
INSPECTOR
N
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION -, /2 —
OWNER Z L/k--114
TYPE OF WORK "I le
DATE /—�y PERMIT,' PIPE
INSTALLER v
INSPECTOR DRAWN BY