HomeMy WebLinkAboutDrain Layers Permit 40 Spruce Lane ijV
TOW OF SO TH WI N DSOR
V .
DEP4TMENT OF POLLUTION CONTROL B/P No.: 33 D
South Windsor, Connecticut,
List.No.:
DRAIN LAYER'S PERMIT hl0 504
NIP
19 , 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein toperform
the work indicated below.at r on the
4WWt side, between_ iiii of zKyo
at premises owned byY �
whose address is
and tv Lay House Drain, Repair House Drain, Lay Ivlain, Other ,
fot occupancy or use,
r _ with *_ `�� Family Units, with acres.
Type of Sewage to be connected under this permit: -
SANITARY SEWAGE ( ), INDUSTRIAL WASTES (-.'),'OR
Connection will be made with } 1 at aw hoxiest of 6.7'*r
Permit to be issued to so As4emoft"
the holder of Drain Layer's License.No,— Permit will expire
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. - -
fot street excavation. .,
SPECIAL CONDITIONS ON" t Oro* .� � 0VU0 #
Signed
Connection Charge Paid Licensed Drain La et
7PI1 ' 2 11 ► Jiro
— Issued by
Tax Collector
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL4dltr (Sig) '
FINAL f ? (Sig),
APPROV D C (Date)
r� r. (Sig):
INSPECTOR ,/
ti
N
i-
�.1
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION o r6',P✓ i
OWNER
TYPE OF WORK
DATE / iq i PERMIT f PIPE
INSTALLER %f ;, .
INSPECTOR �'�� DRAWN BY ;E' 1