HomeMy WebLinkAboutDrain Layers Permit 23 Wentworth Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: .L�-�5 zl
DRAIN LAYER'S PERMIT NO 1617
� 69,1- 75� I9
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at T / / GUC i j'�/GYT �i% on the
side, between
at premises owned by
whose address is a 40l Zp
and to -Lay House Drain, Repair House Drain, Lay-Main, Other
for /7,Q.a ,.,'�.; occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:—
SANITARY SEWAGE t INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to
/Zip j3o uG L�
the holder of Drain Layer's License No. ZO O Permit will expire on_ .16) —0 7" 1�
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 AL
Connection Charge Paid L1 in C- '2/17 j ) Licensed Drain Layer
1, 3 ( 4 Issued by
Tax Collector
Permit Fee: Paid $ _ tQQ
INSPECTION: Check Number: f
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECT R
N
� � Lo? Z6
7 "4
�lbu 5 E
NOT SOUTH WINDSOR POLLUTION CONTROL
LOCATION 2
OWNER Q . A )e'A' VDC'2
TYPE OF WORK S g
DATE PERMIT PIPE ire
INSTA LE
INSPECTOR RAWN - 01
BY