HomeMy WebLinkAboutDrain Layers Permit 643 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _ Z
DRAIN LAYER',S PERMIT - - -
N° 1255
�-2-7 19 7
-Z
Pursuant to written applicat�io/,r, permission is ereby granted tot ice/ns d Drain Laer awed herein to perform
the work i ate ow at (o/7 `� /J / t rJ 7 on t
he
ram,
side, between ./
f
at premises owned by e--y- 067,11
whose address is (/
and to —4Lay 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 X, INDUSTRIAL WA ), 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 sie
Y
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid D Licensed Drain Layer
Z7Issued by '
Tax Collector q
Permit Fee: Paid $
INSPECTION: Check Number: _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(2 /lTil
(Sig)
INSPECT
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N 413
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NOTES ,! SOUTH WINDSOR POLLUTION CONTROL
LOCATION
C / OWNER
TYPE OF WORK
DATE 6-� — PERMIT/ PIPE "
INSTALLER
le
INSPECTOR 6RAWN BY