HomeMy WebLinkAboutDrain Layers Permit 15 Apple Orchard Lan TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' 03
t�a V mo
19 yG
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform a work indica ed below at /S (�
at premises owned by
5 � whose address is
Lay House Drain Repair. House Drain, - and to
for _ Sj�/�����`j Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE , INDUSTRIAL
WASTES ( ), OR Connection wIK
ill be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
js 06Pj)
e Iv
E1QSt CAPUL4
ACT� 9
SPECIAL CONDITIONS `
Desired Starting Date I -Z7- ppb Estimated Time for Completion
Permit to be issued to J SC r z j4.5T7 (21v, (JC,
the holder of Drain Layer's License No.'Z6-, 7Cf Permit will exp
ire thirty (30) days
after date of issuance. The undersigned Drain Layer er y agrees to all the terms and
conditions set forth in the permit and the reverse s de t ereof. Applicant has r ceiv
Town Permit No. and/or CHD Permit No.
Signed
Licensed Dr in Layer
The above named Drain Layer has a valid license .issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 6,-�.� Permit Fee: Paid $ 2r
Check Number
Tax Office Issued by
INSPECTION
Date work started Date completed — ��
Sufficient notification received: Yes No
Special Conditions
APPROVED: 7�
Inspector `pate