HomeMy WebLinkAboutDrain Layers Permit 178 Old Farm Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
t _ 3 South Windsor, Connecticut
l9 List.No.: _
DRAIN LAYER'S PERMIT 3194
Pursuant to written ap Ecatior, permission s hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 6 (� �AA
t r�`GC '
on the
side, between
at premises owned by5outbr,-,tc, Ts Zq77
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
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
0y �`�� Signed
Connection Charge Paid ,a Licensed Drain Layer
Issued by
x Cgllector�
Permit Fee:. Paid $� //llO
INSPECTION: Check Number: y
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR