HomeMy WebLinkAbout21 Hayes RoadTOWN OF SOUTH WINDSOR Amy
DEPARTMENT OF POLLUTION 400TROL gip No.:
South Windsor, Connecticut
List No.: 4400
RA DRAIN LAYER'S PERMIT N?665aI
01 b , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 14 v*s d on the
kt$ side, between taruhm a z6ouist Ism$
at premises owned by 112.19e-
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for MAiAbKtiAl occupancy or use,
with W Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with "'I vivo to a cast irm la
NA At& 2 i.
Permit to be issued to Le DeAn
the holder of Drain Layer's License No._ Permit will expire on 01 D0041111111ft 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
tl
g.
Signed r..
Connection Charge Paid Y40 Licensed Drain Layer
BaceiNt 92 Issued by '
f
V i ", jr#
Tax Collector
Permit Fee:. Paid $ _
INSPECTION: __ ' Check Number:
INITIAL +Q T raI &reA&A 177# Sig)
FINAL 14 _ 'k Sig)
APPROVED (K 00tobors 4 Date)
Sig)
INSP •C R
4
C 14
r
s C
thereof; Applicant has received Town Permit No.
r
and/or C H D Permit No.
for strut excavation.
SPECIAL CONDITIONS'
Signed
Connection Charge Paid Licensed Drain Layer
Issued by ly"t
Tax Collector
Permit Fee:. Paid $
INSPECTION: „ _ Check Number:
INITIAL: so we. (Sig)
FINAL t Sig)
APPROVED 3 Date)
r, Sig)
INSP C