HomeMy WebLinkAboutDrain Layers Permit 17 Rainbow Trail -R - TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No.: _t0
DRAIN LAYER'S PERMIT NO 1494
r4G1 G:l/ T al , 19� r�
Pursuant to written applicatior, permission'is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 4,677 'tiff �L�1Nl3tiW 'T12191L on the
side, between
at premises owned by—
whose address is
and to _ Lay House Drain, Repair House Drain, Lay Main, Other ,
for Q€SL2E/V 714 L occupancy or use,
with &AI Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with R yC
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 Paid Licenseor Drain Layer
Issued by
Tax Collector
Permit Fee:: Paid $
INSPECTION: Check Number: 2
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION RQinbnW T a-j Ln 4- L1/
OWNER U c!- R
TYPE OF WORK
DATE 31 '17 PERMIT I L19 4 PIPE t°
INSTALLER
INSPECTOR r, .;; DRAWN BY