HomeMy WebLinkAboutDrain Layers Permit 284 Quarry Brook Dri TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _ <
DRAIN LAYER 'S PERMIT
N° 1860
_4�_ _ ���, 19_2_�_
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at_ :C„ "�' z
side, between on the
at �premises owned by
r (�
whose address is
and to Lay House Drain, Repair House Drain,
Lay Main Other
for ,
occupancy or use,
with �f �'% Family Units, with
acres.
Type of Sewage to be connected under this permit: `
SANITARY SEWAGE ( � j INDUSTRIAL WASTES J
( ), OR ( )
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit expire on 1
The undersigned Drain Layer hereby agrees to all the terms and conditions set lforth h on e permit and the reverse side
thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Signed
Co nection Charge aid �OC ,U(D
V 3 y , G'9- Licensed Drain Layer
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number: :-92V 3
INITIAL zd— O?a q 6v4 cr� 1�1,vo k
(Sig)
FINAL (Sig)
CIZ61 (4Vel
APPROVED (Date)
INSPECTOR (Sig)
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATIONOWNER
TYPE OF WORK
DATE/,) PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY