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HomeMy WebLinkAboutDrain Layers Permit 059 Ash Road (2) TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL B/P No South Windsor, Connecticut S bOS"9�o List No.: _ DRAIN LAYER'S PERMIT N? 641 19 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at _ L©T 7-0 on the side, between at premises owned whose address is and to r "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: "4 SANITARY SEWAGE (2), INDUSTRIAL WASTES .( ), OR ( ) Connection will be made with Permit to be issued to norm *400 the holder of Drain Layer's License No. i! Permit will expire on 19 The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit an .the reverse side thereof. Applicant has received Town Permit No. and/or C H D Permit No. for street excavation. SPECIAL CONDITIONS r Signed Connection Charge Paid Licensed Drain Layer Issued by ftak I* h Tag Collector Permit Fee: Paid $ ISOM 1 INSPECTION: Check Number: t (,Sig)-- FINAL (Sig) APPROVED (Date) (Sig) INSPECTOR N 1� r Ln In NOTES SOUTH WINDSOR POLLUTION CONTROL LOCATION OWNER TYPE OF WORK DATE Z 4 PERMIT lo4,r PIPE INSPECTOR 4 1 .2, DRAWN BY '