HomeMy WebLinkAboutDrain Layers Permit 24 Rosemary Lane �► t TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER"S PERMIT NO 1256
Jf , 19
Pursuant to written appli do , permission is hereby granted to 4�Licensed Drain Laker named herein to perform
the work indicat d below at r C. ' a-'.°P /' on the
side, betwee
at premises owned bye
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.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Laye
4,216 3 Issued by
Tax Collector
Permit Fee Paid $ _77- Z
INSPECTION: Check Number: -` - _
INITIAL (Sig)
FINAL (Sig)
APPROVED 7- — 7 (Date)
7
/ `�ew (Sig)
INSPECTOR
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NOTES SOUTH WIND OR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE "- -- PERMIT/ PIPE
INSTALIER
INSPECTOR bRAWN BY Z` _, /
y
Z _
1
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n
TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date . 7- 77 Date . 7
The Sanitary Sewer .x. . . Septic System ... . . . . . . . .
at . . . . . .�. . . l j: Cf ?. . . . . . . . . .
or lot #. . . .114j. . . . . . . . has n installed and completed
in accordance with the Town of South Windsor ordinances
and regulations.
Accepted g6 Approved
Ii /Zed / �' Date `� 7—
Y