HomeMy WebLinkAboutDrain Layers Permit 922 Pleasant Valley y `. TOWN OF SOUTH I D W N SOR
DEPARTMENT OF POLLUTION CONTROL f
B/P No.:
South Windsor, Connecticut
List.No.: S'lod►
DRAIN LAYER'S PERMIT 669
Wits L
19 \
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform \`a
the work indicated below at on the
side, between >
at premises owned by e.ur. ,� some
whose address is 11
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 ( , 'INDUSTRIAL WASTES .( ); OR ( )
Connection will be made with JU
Permit to be issued to r tlrwNi
the holder of Drain Layer's License No.111601111106 Permit will expire on 19
The undersigned Drain Layer hereby agrees'to'al the terms and condtions'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 Charge Paid Licensed Drain Layer
Issued byYk �
Tag Collector
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED_0 (Date)
(Sig)
INSPECTOR
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SQtJTH I .DSOR pELUTION CONTROL -
OGATION
OWNER,.. -
TYPE OF .WORK "
PERMIT' PIPE
INSPECTOR DRAWN BY