HomeMy WebLinkAboutDrain Layers Permit John Fitch Boulevard (4) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN-LAYER'S PERMIT N'O 58
Pursuant to written application, permission is'hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at s s « s H
� � on"the
side, between..'
at premises owned by
• $' w � ��,�' .=.;,ate;
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 J _
Permit to be issued to 4�02X.the holder of Drain Layer's License No. ' 19.y � Permit=will expire on ,
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the perk �and't re�i etse si
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for--street excavation.
V
SPECIAL CONDITIONS 4,
Signed
Connection Charge Paid $ Licensed Drain Layer
(Sig) Issued by
Tax Collector
..; Permit Fee: Paid
INSPECTION:
INITIAL (Sig)
FINAL ; (Sig)
APPROVED— (Date)
(Date)
(Sig)
INSPECTOR