HomeMy WebLinkAboutdrain layer permit 1017 Sullivan Avenue (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut 3 � ,UoZ List No.: _
DRAIN LAYER'S PERMIT N9 2222
19_��
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer named herein to perform
the work indicated below 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 ( ), 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
A0/9¢/� Signed
Connection Charge PaiA041,0.tf� Licensed Drain Layer
Issued by
Permit Fee: Paid $
INSPECTION: Check Number: ,0&6,8
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
L