HomeMy WebLinkAboutDrain Layers Permit South Satellite Road (11) .,,. War 6.F SOUTH .W I N DSOR..
DEPARTMENT OF POLLUTION CONTROL
Soyh MVi`ndsor, Connec#icut
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DRA I W LAYER'S+PERMIT O 80 r.
y cu"uantto written application, ermission.is hereb ranted to the.Licensed Drai La named.P Y granted n Layer y herein to perform < ,
{�. the work Indicated below at i`,"�` - on the
t" at premises owned by
4 i .. :whose address is �
ofF
and to. Lay.House Drain,. Repair House Drain, _Lay Main, Other <>
+ fbi r ,. a "+ ;— A. occupancy or use,,-
with, may'Units, with acres.
Type of [ewage to be connected under,this permit
SANITARY SEWAGE, INDVSTRIAL.WASTES, OR
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,.Connection will be'invade with
t'
A - _
S 4.
a Permit to beissued to '` yore
wry. .
` the holder of Drain Lgyer's License No. Permit will expire-on 19
- of
The undersigned,Draiq Layer,hereby agrees to<all the terms'and conditions set forth on th�miVdNd theiteverse side ,
. thereof. Applicant lias reteived'Town Permit No. and/or C H D Permit No.
for'-street-excavation.
tF -SPECIAL CONDITIONS_^
*44
Signed
Connection Charge Paid $ * -`* ... licensed`Dra
Issued by
Tax Collector a
Permit Fe� Paid $
INSPECTION:
INITIAL (Sig)
s
FINAL _ 4. (Sig)
APPROVED: AVf, (Date)
3�+egv�if�--ems J
-. (Sig)
1 INSPECTOR ;=