HomeMy WebLinkAboutDrain Layers Permit 761 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut /JZO
List No.: _
DRAIN LAYER"S PERMIT NO 1253
-� 1C , 19 >
Pursuant to written applicatior, permissio is hereby granted to t e L;gensed Drain Laye named herein to perform
f f ,
the work dicat d low at / C� �' ^tr / ';'' 1 (;% ',' Cif/ on the
r UU side, between � //? 17 95' 75 CJ�
at premises owned by VC 7.0/`
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 (X, INDUSTRIAL WASTE ( ))), QR , �)
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
Signed8t I.-t4,e r-f ,C. .>
Connection Charge Paid l�' Licensed Drain ayer
�^ Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: �
INITIAL (Sig)
FINAL (Sig)
APPROVED — (Date)
f: / 4�;q,I (Sig)
INSP,RCTOR
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_4,41
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NOTES / l / SOUTH WINDSOR POLLUTION CONTROL
w LOCATION
OWNER
b /��/�� TYPE OF WORK o
DATE PERMIT 3 PIPE
INSTALLER
INSPECTOR / DRAWN BY r`'