HomeMy WebLinkAboutDrain Layers Permit 250 Abbe Road (3) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT " �j
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform the ork indicated below at U rS O C
at premises owned by ,�
� ��� � whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE of INDUSTRIAL
WASTES ( ), OR { ) Connection will be made with 1C
Show sketch of proposed work or furnish two (2) copies of separate drawings'.
Uct. p
SPECIAL CONDITIONS
Desired Starting Date rir � Estimated Time for Completion '
Permit to be issued?to
the holder of Drain Layer's License No.�?_ 7 Permit will (expire thirty 30) day
after date of issuance. The undersigned Drain ayer hereby agrees to all th terms and
conditions set forth in the permit and the reverse side thereof. Appli a't has received
Town Permit No. and/or CHD Permit No.
i
Signed
f
L cen a Drai Layer
The above named Drain Layer has a valid license issued by the Sat /of Connecticut and
has filed a satisfactory bond and insurance policy =;a
own of .South Windsor:
�/
Eng neeri partment Date
Connection Charge Paid 3 4 '////214 Per Fee• Paid $ /J�
Lek Numb -[-
er 7 0X--C\,c
_9 Issued by
Tax Office
INSPECTION
Date work started - Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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