HomeMy WebLinkAboutDrain Layers Permit 20 Wentworth Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut r �
List.No.:
DRAIN LAYER"S PERMIT N? 1615
5 3 , 19Z
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at - T�6C1D/�t el� on the
side, between
at premises owned by 4�Z�/9 ,EX,4-,J r�674— L—OT 3 Zi
whose addres 's
and to Lay House Drain, Repair House Drain, Lay-Main, Other ,
i
for / /�� - j _T—"O occupancy or use,
with / O l Family Units, with acres.
Type of Sewage to be connected under this permit: ^Z
SANITARY SEWAGE (t/), INDUSSTRIAL WASTES .( ), OR ( )
Connection will be made with
e
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on /G a/-7/01' 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
\(k L ff ( C`
_ \ � L � 6 7 Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: =�
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
tl
&11 ,4 (Sig)
INS O
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N
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NOTES_ SOUTH WINDSOR POLLUTION CONTROL
LOCATION G o
OWNER OC3.A4644=
TYPE OF WORK 5,r U, 1 "7"
DATE PERMIT PIPE
INSTALLER
INSPECTOR C&RAWN BY