HomeMy WebLinkAboutDrain Layers Permit 187 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No. _
DRAIN LAYER'S PERMIT NO 1544
NOV£mnr,R /G , 19 _
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Pis 7 Qua&cy �Agom 'Dy/116 4or z on the
side, between
at premises owned by f�G�✓A
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 (-A'), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to,be issued.to. %}Ga
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 °Z Licensed Drain Layer
'-16q Issued by
Tax Collector
Permit Fee:. Paid $ 0 .__
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED �I/�jl, - 7 / (Date)
(Sig)
OR
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1
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6
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