HomeMy WebLinkAboutDrain Layers Permit 066 Abbe Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform: the work indicated below at (r6, by _j
at premises owned by o, '—whose address is
and to
Lay House .Drain, Repair House Drain, .. Lay Main, Other ,
for - —occupancy or use, with
Family Units, with I acres.
Type of Sewage to be connectediunder this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
v
SPECIAL CONDITIONS +<aV SZ
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of -Drain Layer's License No.:{ j ,` 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. Applicant has received
Town Permit No. and/or CHD Permit No.
r Signed •fr11- L'i /i�:Q,1/.i`� _
�, (J Licensed Drain 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 Permit Fee: Paid
' Check Number ,
Issued by "'`
Tax Office
INSPECTION
Date work started Z��� Date completed
Sufficient notification received: Yes No
1pecial Conditions
APPROVED:
Inspector Date