HomeMy WebLinkAboutDrain Layers Permit 9999unklot 3 Avery St TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.. _
DRAIN LAYER'S PERMITS 3591
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19 r,
Pursuant to written,appli tior, ermiss' is hereby ranted to the Licensed Drain Layer named herein to perform
the work indicated below at . on the
side, between
/ /' i) . 7
at premises owned by 1,00''
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other ,
for occupancy or use,
with (5"Y'1-9. Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, INDUSTRIA WASTE ( ,,), OR
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Connection will be made with r
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 Paisir ..� t > ALUsed Drain Layer
t�' s' i_ Issued by -''�^
t- Tax Collector
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/ Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR