HomeMy WebLinkAboutDrain Layers Permit 251 Skyline Drive (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL *
B/P No.:
South Windsor, Connecticutr% '� ,
List No.: _
Ao DRAIN LAYER'S PERMIT
%� N. 638
;
_ , I 9
74
Pursuant to written apL71
atior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 4--4 FL 01tzu-r 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 tub h' ,r Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (Z ), INDUSTRIAL WASTES ( ), OR
Connection will be made with fiLVdzV.% tip) I
Permit to be issued to 1'*Jr
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
�3
Signed -
Connection Charge Paid Licensed Drain Layer
!� d4r Issued by
Tax Collector
Permit Fee: Paid $ _
INSPECTION: Check Number: • ��'
INITIAL (Sig)
FINAL (Sig)
APPROVED -�— � � (Date)
V (Sig)
IN81 DC-TOR
N
NOTES SOUTH WINDS R POLLUTION CONTROL
LOCATION '76
OWNER
TYPE OF WORK-
DATE ERMIT 3 PIPE
INSTALLER
INSPECTOR DRAWN BY. � '