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DEPARTMENT OF HEALTH
TOWN OF M O N TV I LLE TAX MAP LOT PERMIT
PERMIT TO CONSTRUCT ❑ Well
❑ New Sewage Disposal System
C Check Q Replacement Disposal System
p Cash
Permit Fee $__.21_00--------- - Payable to the Town of Montville
Lot Location -----.Clt-'------------------------------------ Size
Owner - Tel. No.
Address -Z~1 -
Contractor License No.
Address
- -C-` '4h z y...... ' Tel. No.
Soil Basement Facilities ( ) Baths ( )
Residence No. of Bedrooms Commercial
Water Dug Well ( ) Drilled { ) Municipal ( )
Septic Tank - Capacity in Gal-
( ) Garbage Grinder
( ) Dry Wells No.
( ) Leaching Bed
( ) Trenches
( ) Galleries
No. of Feet Depth Width
Size of Stone Size Pipe _
Instructions: 1) No backfilling allowed until final inspection.
2) On space at .right draw plan.
Locate 3) House Road
4) Property Lines Water Supply
5) Septic Tank - Dry wells or Leaching Tr.
6) Distribution Box
Water pply d leaching on adjoining property.
Signed:
Date
Contractor
Approved By - - - - - - -
Sanitarian
The private sewage system serving the above premises was constructed essentially in
accordance with plans filed with this district and the terms of the Permit issued, This
Certificate shall not be construed as permission to create or maintain any sewage nuis-
ance and in the issuance of the certificate, the Town of Montville Health Department
assumes no responsibility for the future operation and maintenance of the system.
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DEPARTMENT OF' HEALTH
TOWN OF MONTVI'LLE
TAX MAP - LOT PERMIT ~l ;t
PERMIT TO CONSTRUCT ❑ Well
❑ New Sewage Disposal System
n Check ❑ Replacement Disposal :System
Cash t) Ile "p V
Permit Fee Payable to the Town of Montville 6 /T
Lot Location Size
ner Tel. No.
Address Address -
.`2
7
Contractor - License No.
Address - Tel. No.
Soil Basement Facilities ( ) Baths
( ) l\\
Residence No. of Bedrooms Commercial
Water Dug Well ( ) Drilled (tom Municipal ( )
Septic Tank - Capacity in Gal. ' 04le oe
( ) Garbage Grinder
(1') Dry Well, No. e
( ) Leaching' Bed f/
( ) Trenches 4 Y I
( ) Galleries
I
No. of Feet Depth Width I
five.-
Size of Stone Size Pipe ~
-Instructions: 1) No backfilling allowed until final inspection.
2) On space at right draw plan. L L
W li'
Locate 3) House Road
4) Property Lines - - - - Water SuPPIY
5) Septic Tank - Dry wells or Leaching Tr. j
6) Distribution Box
7)' Water Supply and leaching on adjoining property.
Signed: - Date
Contractor
Approved By - -
Sanitarian "
The private sewage system serving the above premises was constructed essentially in
accordance with plans filed with this district and the terms of the Permit issued. This
Certificate shall not be construed as permission to create or maintain any sewage nuis-
ance and in the issuance of the certificate, the Town of Montville Health Department
assumes no responsibility for the future operation and maintenance of the system.