HomeMy WebLinkAboutDrain Layers Permit 117 Wentworth Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2627
lq d '
Pursuant to written aP 1' atior, permission is herebyrante
g the,Licensed Drain Layer named herein to perform
d
the work indicated below at 'y
side, betwee on the
at premises owned
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 ( j, 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 The undersigned Drain Layer hereby agrees t 19
o all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
------------
0, /.� �1
Connection Charge Paid Signed
Licensed Drain Layer .
Ytilt (( ��? L t Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig
FINAL �,���• � J ���✓
(Sig)
APPROVED (Date)
INSPECTOR (Sig)