HomeMy WebLinkAboutDrain Layers Permit 125 Wood Pond Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2761
Pursuant to written applicacior, permission i hereb gra ed t the Licensed Drain Layer named herein to perform
the work indicated below at / Ot�
on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, La Main
Y' 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
ajgq _d3
Signed
Connection Charge Paid , w Licensed Drain Layer
lit-�-t�Gl
Tax Collector Issued by
Permit Fee:. Paid $ _4Ja GU
INSPECTION: Cheek Number: - 1161
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)