HomeMy WebLinkAboutDrain Layers Permit 111 Robert Drive (2) -�" TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut /
List No.:
DRAIN LAYER'S PERMIT Na 793
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for ,A 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 st:
c
Permit to be issued to Tr,.
the holder of Drain Layer's License No. W ; r• ".'a 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 {. Licensed Drain Layer
" .3 Issued by r`,
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL cy (Sig)
APPROVED (Date)
T. ' (Sig)
INSPECTOR