HomeMy WebLinkAboutDrain Layers Permit Abbe Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' 5366
19
Pursuant to written application, permission is hereby granted to "the Lice sed Drain Layer
named herein to perform the work indicated b low at CO., ; �� ('' ,A s
at premises owned by whose address is
Lay House Drain, Repair House Drain, ., Lay Main, Other
for
,
Family Units, occupancy or use 'th
. with acres. ,
}
Type of Sewage to be connected under this permit: SANITARY SEWAGE( ), INDUSTRIAL
WASTES ( ), OR ( ) w"' Connection will be made with
Show sketch of propdsed work or furnish two (2) copies of separate drawings.
- T
SPECIAL CONDITIONS I rL f L
q 1/1(�. C. Lf
Desired Starting Date / Estimated Time for Completion / /-'
Permit to be issued to v ,� 1)4
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the% terms and
conditions set forth in the permit and the reverse side thereof. -A plicant s received
Town Permit No. and/Or CHD Permit No. K? 330
Signed „
Licensed Drain ayer
r—�
The above named Drain Layer a valid license issued by the Sta _,of Connecticut and
has filed a satisfactory bond surance policy in',the name of th wn of South Windsor:
j ng%eerin artment Date
i
Connection Charge Paid
g -` Permit' Fee: Paid $ 'C
Check umber �J
- J / Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient_ notification received: Yes No
Special Conditions
APPROVED:
Inspector pate