HomeMy WebLinkAboutDrain Layers Permit Pleasant Valley Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No..
DRAIN LAYER"S PERMIT NO i1554
, 19 -7,g
Pursuant to written applicatior, permission ishereby 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 4/51jCj�
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be (zonnected under this permit:
SANITARY SEWAGE (K), INDUSTRIAL WASTES ( ), OR
Connection will be made with
Permit to be issued to ee�/1
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 Charge Paid Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: -
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR