HomeMy WebLinkAboutDrain Layers Permit 211 Quarry Brook Dri sly �'iD , 7#
TOWN 0� SOUTH
W R
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut ! '
List.No.:
DRAIN LAYER'S PER N? 1649
// 3 19 -
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform&
u
the work indicated below at Q �/ I ar n c CA r
b on the
side, between
at premises owned EHouse
whose address is
and to Lay House Drain, Reparain, CLay Ot
for cupancy or use,
with Famil its, with ;cZes.
Type of Sewage to be connected under this permi
SANITARY SEWAGE ( , INDUSY 7 TES
Connection will be made with ex
Permit to be issue to
the holder of DA& Layer's cense No. Per will expire on 19
The undersigned in Layer reby agree 1 t to s and condit' ns set forth on the permit and the reverse side
thereof. Applicant ha ceive own Permit and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIO
Signed
Connection Charge Paid ^^���-7� Licensed Drain Layer
4`0-6kIt,-- ' V Issued by
Tax Collector
s
Permit Fee: Paid $
INSPECTION: Check Number: - 2 7
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)