HomeMy WebLinkAboutDrain Layers Permit 664 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut 61�3 0
List.No.: _
DRAIN LAYER'S PERMIT N? 1277
/0 27
, 19
Pursuant to written applicatioVermiss; is
hereby grante to the Licensed raip Layer named herein to perform
the wofr�k�indicat below at C�/C7/ n the
�vG side, between �1
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:
SANITARY SEWAGE Y \ INDUSTRIAL�AS , OR ( )
Connection will be made with C� "yd
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 side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
t
j Signed v
Connection Ch a Paid / lj Licensed Drain Laye
- V-7 Issued by
Tax Collector _
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
rr
Y l (Sig)
INSPECTOR
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17
NOTES SOUTH WINDSOR PO ION CO ROL
LOCATION il C
OWNER 4v" 0g e, !�
TYPE OF W RK M7Ce
DATE -'/6-77 PERMIT,3 PIPE
INSTALLER
INSPECTOR DRAWN BY