HomeMy WebLinkAboutDrain Layers Permit 290 Abbe Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT P` 5 5 5 `
r
19 it ii
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work 'indicated below at v Af f�/ /��
at premises owned by /�, ' /�/Z f ��,, whose address is
L and to
Lay House Drain, Rgpair House Drain, Lay Main, Other
for / � ,t", occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (/INDUSTRIAL
WASTES ( ), OR ( ) 4 15 / L - Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired St rting Date ! �; Estimated ime for Completion ,(� ,jj
Permit to be issued to
the holder of Drain Layer's License No. 0 {: Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the Perms and
conditions set forth in the permit and the reverse side thereof. Appli r}t has received
Town Permit No. and/or CHD Permit No. x
Signed
Lice sed An Layer
The above named Drain Layer has a valid license issued by the 6tatee 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 $a5ao 44+-IZ09:
Check Number
-20�11
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
,774,
APPROVED.- / -e. -
Inspector Date