HomeMy WebLinkAboutDrain Layers Permit 154 Wood Pond Road TOWN OF SOUTH WINDSOR
DEPARTMENT' OF `POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 3141
Pursuant to written appli5,atiDor, permission is he eby anted t yth , Licensed Drain Layer named herein to perform
the work indicated below at fly o� � � � S� on the
side, betty n
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 ( ),.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
Signed
Connection Charge Paid Licensed Drain Layer
�a
Issued by
".Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: u ( —
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig) +
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