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HomeMy WebLinkAboutDrain Layers Permit 6 Ronda Drive TOWN OF SOUTH WINDSOR DEPARTMENT OF POLLUTION CONTROL South Windsor, Connecticut B/P No.: List.No.: /4- DRAIN LAYER'S PERMIT - T° 2034 ) 19J li Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at ^C!l on the side; between at premises owned'by_ Z-lC/�'f,� /cz whose address is and to Lay House Drain, " Repair House Drain, _Lay'Main Bier' for n �An occupancy or use, UrG with �" Family Units,.with acres. . Type of Sewage to be Roinnected under this permit: SANITARY SEWAGE (t1-, INDIJSTRIAL WASTES ( ),.OR ( ) _ Connection will be made with 1l/(' Permit to be issued to'L the holder of Drain Layer,s License No. Permit will expire on 1 The undersigned Drain Layer hereby agrees to all the.terms and conditions ser 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 CONDITIQNS' G C�i Signed Connection Charge Paid �� Licensed Drain Layer 1 Tax Collector Zi�_ � ��.. i-✓�' 1- Issued by Permit Fee:. Paid $ C'_ �4_-- f INSPECTION: Check Number: INITIAL } (Sig) FINAL (Sig) APPROVED © (Date)` INS CT R (Sig)