HomeMy WebLinkAboutDrain Layers Permit 19 Wentworth Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.-.
South Windsor, Connecticut ,
List No.:
DRAIN LAYER'S PERMIT - 6.16 ,10
N. 1648
19
Pursuant to written applicatior, permission is hereby granted)to�the
.�Licensed Drain Layer named 4erein to perform
the work indicated below at O 7r' G(/-�•c-(��i f1-t on the
side, between
at premises owned by
whose address is
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:
SANITARY 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 ��clln ( �� ,,'Licensed Drain Layer
t D Issued by
Tax Collector /1
Permit Fee:. Paid $ ___L S Q�✓
INSPECTION: Check Number: =
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR