HomeMy WebLinkAboutDrain Layers Permit 31 Wentworth Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'-S PERMIT NO 1633
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Z7/ � w L�r�f✓rJ7� j` on the
side, between
at premises owned by—
whose addreys is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for KD��T//9L-.(— A
��0��T_occupancy or use,
with Family Units, with _acres.
Type of Sewage to be connected under this permit: 11,u
SANITARY SEWAGE (&,-)y, INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to /c-� /3 ou L
the holder of Drain Layer's License No. Permit will expire on -0 75' 19
The undersigned Drain Layer hereby, agrees to all the term 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 $ _may
INSPECTION: Check Number: , f0&�=7
,g-'s pro Cle,14f
INITIAL (Sig)
FINAL (Sig)
APPROVED .�` Z F (Date)
INSPECTOR (Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Wg G : L
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY