HomeMy WebLinkAboutDrain Layers Permit 55 Wentworth Drive (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No
DRAIN LAYER'S PERMIT 61 (093
N° 1814
er' Z4-- , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
/
the work indicated below at O on the
nevi �" L✓ o (- '� r-.
side, betty enc
at premises owned by - > �� 1 f' '4� a 'I ( 'e r
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other.
for .�?fie ._ ,(occupancy or use,
with = Family Units, with acres.
Type of Sewage �o)benected under this permit:
SANITARY SEWAGE USTRIAL WASTES .( ), OR )
Connection will be made with Ir
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
ec;�7
1y 3
� Signed
Connection Charge Paid Z/60 icensed Drain er
Issued by
Tax Collector ere,
/0 I�/ ov `ot 3D
Permit Fee:. Paid $ l5
INSPECTION: Che ber: y�
� ��7u?l
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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