HomeMy WebLinkAboutDrain Layers Permit 290 Abbe Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT _wm `L 8 4
Pursuant to written application, permission is hereby granted th Lice Dr
n Layer
named herein to perform a work indica ed_ e ow at �Q / l
at premises owned by whose address is
and to
Lay House Drain, �ir Repa'r House Drain, Lay Main, Other
for J �; occupancy or uYINDUSTRIAL
Family Units, with acres. —
Type of Sewage to, b connected under this permit: SANITARY -SEWAGE
WASTES ( ), OR 4f J 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 Starting Date /0 Estimated Time for Completion J i
Permit to ,be issued to C 0 U
the holder of Drain Layer's License No. 0-7 ,9�s 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.: -.p iiant/has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by th State of Connecticut and
has filed a satisfactory bond and insurance poll c in then a of tine of South Windsor:
/b f!Z
ginee ing D�p ment Date
1
Connection Charge Paid �� erm t Fee: Paid $
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Check Number t
Issued by +
Tax Office
INSPECTION k �_
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
_y