HomeMy WebLinkAboutDrain Layers Permit 119 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL Bhp No.: A
South Windsor, Connecticut '
List No.: S_6r)XM
DRAIN LAYER'S PERMIT 707
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 119 DtjVC, r on the
I0:1 ide, between
at premises owned by
whose address is
and to ILay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with I,,n* W Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with :~may (w 7) D.Unde ja
Permit to be issued to Aj,`Qit L.0#Ir•
the holder of Drain Layer's License No.— iaiiiF«• J`°,i'4 Permit will expire on go i 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
Signeti
Connection Charge Paid `f;;•• Licensed Drain Layer
Issued by XNAMW .jam. jrs
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: a�i'a i
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N 4
�1
/ E
74
99.0,
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION p
.. OWNER
TYPE OF WORK .
DATE d PERMIT PIPE
INSTALLE
INSPECTOR _RAWN_BY