HomeMy WebLinkAboutDrain Layers Permit 301 Quarry Brook Dri TOWNS OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: -��!F—,��
DRAIN LAYER'S PERMIT NO 1835
19.2
Pursuant to written applicati/or, permission is hereby granted to the Licensed Drain Layer named herein to"perform
the work indicated below at 2-5 J TU 2, on the
side, between
at premises ownedt — Z?
by
whose address is Ate°
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:d
SANITARY SEWAGE (t/r, INDUS AL 'WASTES ), OR ( )
Connection will be made with- D / �
e6
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 �7
Conn ctio Charge Paid 70 b' Licensed D Layer
ft a-2�
Issued by
Tax Collector da 7j �s'Do
Permit Fee:. Paid $ _
INSPECTION: Check Numger: #aaa
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Z,2t
OWNER
TYPE OF WORK
DATE MaTZ2 PERMIT PIPE 62-v
INSTA R
INSPECTOR dJ DRAWN BY -