HomeMy WebLinkAboutDrain Layers Permit 219 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List.No.: _ Z
DRAIN LAYER'S PERMIT NO 1650
3 , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named he 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
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 Z92 G Cx V--,A—
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
Signed . ���
Connection Charge Paiid�� License tm a Layer
Tax Co
� � �� �U Issued by
llector CC
Permit Fee:. Paid $
INSPECTION: Check Number: v
INITIAL (Sig)
FINAL
(Sig)
APPROVED (Date)
INSPECTOR (Sig)