HomeMy WebLinkAboutDrain Layers Permit 296 Quarry Brook Dri TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: - - 616 9 O
DRAIN LAYER'S PERMIT NO igll
, 19�.
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at (/�, ,�yk '1�-• ,a on the
side, between
at premises o ned by
whose address is � r
and to Lay House Drain, Repair House Drain, Lay-Main, Other
forte 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 W �� 4;VZ,1(7
Permit to be issued to
the holder of Drain Layer's License No. ermit 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
A-0 e i /`� /� Signed �l�o, ,
CTng �,Charge Paid b0• 00 IV- License rain Layer
_
Tax Collector Issued by /3J71
Permit Fee:. Paid $ 06
INSPECTION: Check Number, �'?D
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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VAIJ
f-col-/
f~ l" fair
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE - -PERMIT ti';'' PIPE
INSTALLER
INSPECTOR DRAWN BY