HomeMy WebLinkAboutDrain Layers Permit Building 9 Twin Circ TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL Bhp No.:
South Windsor, Connecticut -3
List No.: _
DRAIN LAYER'S PERMIT NO 2221
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by _ All
whose address is
a
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
-- -- SA-NI-T-ARY SEWAGE ( ), INDUSTRIAL WASTES-( ), OR ( )
Connection will be made with
Permit to be issued to
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
Signed
Connection Charge Paid Licensed Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: f d�
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)