HomeMy WebLinkAboutDrain Layers Permit 19 Ravine Road TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 2103
�W��� 19
Pursuant to written application, per fission is hereby, gra red to the Licensed Drain Layer named herein to perform
the work indicated below at �C l`r��/ /7 -, 7 / on the
side, betw��ee��n``,,
at premi s owned by
whose address is --
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:
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.
SP �ALONDI IONS
t
Signed
Connection Charge Paid >- Licensed Drain ayer
lC/ 't��Issued by—zx
C„—
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig) CC,V 2
FINAL (Sig)
APPROVED `� — C� (Date)
G (Sig)
IN T