HomeMy WebLinkAboutDrain Layers Permit 174 Rosemary Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2294
19
Pursuant to written applicatior, permissio is hereby granted to the Licensed Drain La er named herein y to perform
the work indicated below at �o on the
side, between
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
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
Connecti rge Paid d Licensed Drain Layer
Issued by
ax Collector
Permit Fee: Paid $
3
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
i
N
i
x
NOTES SOUTH WINDSOR POLLUTION COYfROL
LOCATION / 7 `ra F't a �4 �-
OWNER. CQr` Yh cz r
TYPE OF WORK
DATE *3 --7— 9 ( PERMIT PIPE
INSTALLER ,, e x
INSPECTOR Di A.WN BY S