HomeMy WebLinkAboutDrain Layers Permit 10 Woodside Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER"S PERMIT 3142
I , 19 � L1
Pursuant to written app//ll�icati//or, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at j U 1� )T -�.0 � �Q on the
side weep
r ,
at premises owned by I I, d
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
— �/7 / 7'(/ Signed
onnection Charge Paid Licensed Drain Layer
Issued by
x Co�ll(e�or
$
Permit Fee: Paid
y loC/ y
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
N
w
7�AV
rj
a
to
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION , � �
- OWNER ` A c
TYPE OF WORK Q
DATE / /0 6 PERMIT 14 11 PIPE
INSTALLER
INSPECTOR - DRAWN BY