HomeMy WebLinkAboutDrain Layers Permit 45 Rockledge Drive ivnn yr avu 1'rI WINUbUK
DEPARTMENT OF POLLUTION CONTROL
_
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? .. 002
19 3
Pursuant to written applicationpermission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at OCX(k 14 jp A ir- on the
side, betwee
at premises 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
i
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
�i�Connect' arge Paid v!i lif Signed� Licensed Drain Layer
/ Tax Collector Issued by
� q
Permit Fee:. Paid $ � / �3
INSPECTION: Check Number: �G Z Z4
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)