HomeMy WebLinkAboutDrain Layers Permit 139 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 2162
Pursuant to written a ppli{ccaatio�r{,�permis/sion is ere gran d to he Li nse�dy{-Drain Layer named herein to perform
the work indicated below at (6l l[-UY7 4n �-F'
on the
side, be7�1,1
en
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 ( 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 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
2 ,i)yq C)
Signed
Connection Charge Paid QQ,Q U Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number.
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)