HomeMy WebLinkAboutDrain Layers Permit 76 Wentworth Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2918
l , 19 al�15
Pursuant to written applicat/ior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at— t3 •� �,�1 toy/hl�t�`� '�y � y
on the
side, bet. n
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
o�5 � � l�-�� •
Signed
Connection Charge Paid /n�), 6 L) Licensed Drain Layer
' r
� -� A Issued by
Tax Collector /
•/ Permit Fee:. Paid $
INSPECTION: Check Number: C'3191
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)