HomeMy WebLinkAboutDrain Layers Permit 919 Pleasant Valley TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMITp 668
fib, , 19
Pursuant to written applicatior, permission is hereby granted to_the Licensed 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 ,
for occupancy or use,
with Family Units, with acres,
Type of Sewage to be connected under this P ermit:
SANITARY SEWAGEIISL OR
Connection will be made with
Permit to be issued,to
r140
the holder of Drain Layer's•License No. Permit.wilt expire on � 19
The undersigned Drain Layer hereby agrees to a'll'the term's and conditions set forth on the permit and the-reverse side
thereof. Applicant has received Town Permit No. and/or-C HD Permit No.
for street excavation.
SPECIAL CONDITIONS
t ,
Signed
Connection Charge Paid Licensed DraipOtayer
Issued by +� ►.
Tax Collector
Permit Fee: Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
0
0
I
a
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ,4.
OWNER
TYPE OF WORK
DATE iu - PERMIT h PIPE x
INSTALLER
INSPECTOR µ', DRAWN BY