HomeMy WebLinkAboutDrain Layers Permit High Street and Grah k OF W N
N � Q T 1 DSOR
3:9`F RTMENT� OR' r10N CONTROL: ,
A " F South Windsor, Connecticut
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A YER'S: -ERA.1
T 39
- _ 19 73
Pursuant to written application,permission is hereby grated to.theLicensed Drain Layer named herein to perform
the work indicated below at "
on the
side, between
at premises owned by
who ,address is'
apd`to Lay House Drain, Repair House Drain, Lay Main, Other
r _
Y�----- ,� occupancy of uses,
with _ Family Units, with acres
Type of Sewag
e ge to be connected under thispermit:
SANITARY SEWAGE)E) INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be`issued to
� the holder of Drain:LayerN License No. �.• Permit.will expire on�� ,19
The undersigned Drain Layer hereby agrees to al t`e terms and conditions set forth on the �e-rm' t an ,t a
:i side
� d
t ,
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
- - _ -- -
for street exjjc��avation.
text— +Jt
Signed: z:
Connection Charge Paid i ns ra Layer s:
(Sig) Issued by
Tag Collector 4 ;
Permit:Feet Paid,
t :
` s q
INSPECTION:.
INITIAL : �5 -'ti ep a wit (Sig) k..
FINAL (Sig)
APPROVED. . . (Date)
INSPECTOR (Sig) 9