HomeMy WebLinkAboutdrain layer permit 746 Sullivan Avenue TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut S6/09
List.No.: _
DRAIN LAYER"S PERMIT N? 1138
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side,•between f,
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 ( ), 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
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: ,
INITIAL (Sig)
FINAL (Sig)
APPROVED 'r (Date)
(Sig)
INSPECTOR
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4,s 4s
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawing not to scale. LOCATION . 746 Sullivan Avenue
OWNER PRANCKUS I Albert G. & Joanne F.
TYPE OF WORK house Connection
DATE 09-a1-7G PERMIT 1138 PIPE G '-' ,6 S
INSTALLER Lamson W - 6 8
, INSPECTOR DRAWN BY