HomeMy WebLinkAboutDrain Layers Permit 224 Scott Drive TOWN OF SOUTH -WINDSOR
_DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N? 2i01
, 19
Pursuant to written applicatior, per fission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at—
---on the
side,-between
at premises owned by �� J
whose address is
and to Lay House Drain, Repair House Drain, Lay Main,`, Other
for occupancy or use,
with Family Units, with I acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j,.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 '" 19ry
The undersigned Drain Layer,hereby agrees to all the terms and conditions set forth on the permit and the verse side
thereof. Applicant has received Town Permit No. and/or C HD Permit No.
for street excavation,
_ SPECIAL CONDITIONS
Signed `
Connectio barge Paid in
Vk Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: - �41 _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION z Z y SCo ! �!
OWNER
TYPE OF WORK tn1.s7-,ac.L L-ATFPr44
DATE !o-5` o PERMIT PIPE
INSTALLER ,--_cco. lc-)
INSPECTOR L. DRAWN BY