HomeMy WebLinkAboutDrain Layers Permit 311 Quarry Brook Dri (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List.No.:
DRAIN LAYER"S PERMIT NO 1861
Ci: .&P 7 `l , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at L 5•0 Oun, 11- 1.1,E � on the
side, between
at pr is s owned by C r
a
whose address is ley
c.
and to Lay House Drain, Repair House Drain, Lay-Main, �—O—t—her
for "'�� r occupancy or use,
with .1 Family Units, with acres.
Type of Sewage to be co nected under this permit:
SANITARY SEWAGE ( INDUSTRIAL.WASTES ( ), OR ( )
Connection will be made with
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
1Y p
I7 70` Signed. ._ _
Connection Charge aid L1r7o 0o --� Licensed- in Layer
Charge
Issued by
Tax Collector /
Permit Fee: Paid $ _SSA�0
INSPECTION: Check Number: •
INITIAL �o� aSU &oar,,/ �� o�
(Sig)
FINAL (Sig)
APPROVED (Date) C�
(Sig)
INSPECTOR
V
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N Iv} IQ
e^
lam- 4.
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Q
OWNERc.fn�
TYPE OF WORK
DATE PERMIT PIPE v'
INSTALLER
INSPECTOR '' DRAWN BY