HomeMy WebLinkAboutDrain Layers Permit 753 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N? 2529
Pursuant to written applicatior, permission is hereby:,granted to t Licens d Drain Layer named herein to perform
the work indicated below.at / � on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
occupancy or use,
for
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, INDUSTRIAL WASTES .( .), 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 side
thereof. Applicant has received Town Permit No. and/or C H-D Permit No.
for street excavation.
SPECIAL CONDITIONS
OS5' 5-
� Signed
Connection Charge Paid Licensed Drain Layer
�{f lit Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
(Sig)
INITIAL
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR