HomeMy WebLinkAboutDrain Layers Permit 1100 Pleasant Valley j - TOWN OF, SJQ _TH WINDSOR
DEPARTMJE OF OLLUTION CONTROL
South Windsor, Connecticut
S76"4 O
DRAIN LAYER'S PERMIT NO 199
19
Pursuant to written application, permission is hereby granted to the Licensed Dr in Layer named herein to perform
the work indicated below at /Otl Sf*071 d_ , 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 permit:
SANITARY SEWAGE, INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be issued to /Y t 8 11/ J4/A &E I E
the holder of Drain Layer's License No. ZM6 yy Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the peter ancf the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
4f
Signed '`/f.' t f/ (Q 2a-7Ay V
Connection Charge Paid $ Licensed Drain Layer
i
(Sig) issued by
Tax Collector
` Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
FINAL //jj (Sig)
APPROVED Veb CAd 0,OS_ /,rrejAâ–º/C F (Date)
oC ' .
.,c.,,. Si
\' INS CTOR (Sig)
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