HomeMy WebLinkAboutDrain Layers Permit 100 Skyline Drive - TOWN-OF , SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: �6alSsS
DRAIN _LAYER'S PERMIT
O 1010
, 19
Pursuant tp written application, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at 46t on the
side, between_ AwAir
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain., Lay-Main, Other
for
occupancy or use,
with Ont, Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE(k), INDUSTRIAL WASTES OR ( )
Connection will be made with SIZ Ate Rue
Permit to be issued to NOU
the holder of Drain Layer's License No. Vnl' '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. .
=�PEfIriI:�ONI3Y`I �- :.:-- .�_ .. W..-.e -,.�.. .-�.• rs;•:_emd-:.. _..a_ _,�, -:��.:s� ,r�•n� -
Signed
Connection Charge Paid Licensed Drain Layer
r9a Issued by iw .
Tax Co lector
Permit Fee:. Paid $
INSPECTION: Check' Number:
-INITIAL (Sig)
FINAL (Sig)
_ APPROVED .(Date).
, c . (Sig)
Rt;CTOR
Lo f-
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