HomeMy WebLinkAboutDrain Layers Permit 105 Wood Pond Road ' TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 2372
4✓'c , 19 c
Pursuant to written applicatior, permission is hereby nted/too the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, bet n I _
at premises owned by '�
01
whose address 's
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 ( 1NDUSTRIAL WASTES
/( ), OR ( )
Connection will be made with �—
Permit to be issued to �{ .
the holder of Drain Layer's License 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 ge Paid (f`U 3 - Licensed Drain Layer
Issued by X,
Tax Collector
dl®
Permit Fee: Paid $ _1-22`- I. l
INSPECTION: Check Number: 3ZZ
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
_ o
,
e
e
NOTES SOUTH T41NDSOR POLLUTION COIN ROL
LOCATION /t, 0 1
OWNER
TYPE OF WORK
DATE — 61 PEMMIT `c�3 PIPE
INSPr CT OR DRAWN By