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HomeMy WebLinkAboutDrain Layers Permit 004 Austin Circle TOWN OF SOUTH VW!NDSOR DEPARTMENT OF PUBLIC WORKS , J BUREAU OF POLLUTION CONTROL ©� DRAIN LAYER'S PERMITd 0 5905 19 Pursuant to. written application, permission is hereby granted to the Lice ns d Dr.a 'n. L yer �named erei to perform the work indicated below t S� ► i�t premis s wned by whose address is ,/ ,- ,7. a "to Lay House Drain, Repair �ouse Drain, TLay Main, Other , for a occupancy or use, with aS/,T,cta — Family Un t , with 1 �. acres. - - Type of Sewage to be connected under this permit : SANITARY SEWAGE INDUSTRIAL WASTES ( ) OR ( ) Connection will be made with wtiv: l` Show sketch of proposed work or furnish two (2) copi s 'of separate drawings. a SPECIAL CONDITIONS ' ` .. Ly i' S '� ► ::`( .. Desired Starting Date - 777 Estimated Time for Completion _._ Permit to be issued to J, cscp/ the holder of Drain Layer's License No., Z;6111;_T%RbC1 Permit will expire thirty (30) days-after ,date of issuance. The ,un.dersigned 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 . �►' 4# $,""" and/or' GHD Permit No Signed ��iiccenseneiesd ; :ainr The above named Drain Layer has a 'val issued b he State 'of Connecticut and has filed-a , satisfactory bond and insurance policy in .the name of the Town .o.f South Windsor: E' ineering Dept. Date 4 Permit Fee Paid $ � - - Check N ber ul(gC5 Connection Charge Receipt No. , Ditted Issued by � r INSPECTION Date work started Date completed ` Sufficient notification ec ve : es No: Special Conditions APP Afigpector Date