HomeMy WebLinkAboutDrain Layers Permit 804 Pleasant Valley TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
� List No.: _
DRAIN LAYER'S PERMIT ? 2900
19F 3
Pursuant to written applicatior, permissiows hereby gra ed to the Licensed Drain er named herein to perform
the work indicated below at � G� d=✓ on the
side, between
at premises owned by�L i��
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 io be connected under this permit:
SANITARY SEWAGE ( ), 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
Signed
Connection Ch aid yL� (i� Licensed Drain Layer
Issued by
Tax/aector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)