HomeMy WebLinkAboutdrain layer permit 53 Kelly Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT NO 1672
jaly 2- pig7
Pursuant to written applica 'or, permission_ is hereby granted to the icensed Drain Layer named herein to-perform
the work indicated belo at � on the
side, between
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 (AX), INDUUSTRIAL WASTES ( ), OR ( )
Connection will be made with S k Lie S r 4—� u �� � t� U ( r- e
Y C- `7 `<
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 an ;he reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SP CIAL CONDITIONS -
, ( Signed
Connection Charge Paid 0Ln
"� Licensed Dr Layer
13 Z® Issued by C
-Tax Collector
Permit Fee:. Paid $ eL
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
7/i 1
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76
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NOTES SOUTH WINDSOR POLL gPIPE
CONTROL
LOCATION
OWNER
TYPE WO
DATE IT
INSTIKLIZK
INSPECTOR DRAWN BY
1
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK L
DATE PERMIT PIPE e/
INSTALLER C.
INSPECTO DRAWN BY odh