HomeMy WebLinkAboutDrain Layers Permit 015 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT '! 5763
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Pursuant to written application, permission is h reby granted to the
Li�cepns Dr ' ay named herein to perform the work indicated below ,at
T - at pre ises own,ed y. 5 ��� �.0� 11
whose ddress is ih Sw ,� SG`^ and to
Lay House Drain, Repair H se Drain, Lay Main, t er ,
for occupancy or use, with
Family Units , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE (1/
INDUSTRIAL WASTES ( ) OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings,
11
SPECIAL CONDITIONS
Desired Starting Date Z Estimated Time for Completion
Permit to be issued to Cd c•�cl�on CO .
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. Applicant has received Town Permit No. yWa and/or
CHD Permit No. .
Signed 011'
Licens D ain Layer
The above named Drain Layer has a valid icense issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the .
name of the Town of South Windsor :
En t
eering Dept. Date
Permit Fee Paid $ a,j,0 Check Num r ::0 �p16Z
Connection Charge Receipt No. L- I eo ADated
Issued by
INSPECTION
Date work started t, Date completed
Sufficient notification recelve : Yes No
Special Conditions
APPROVED:
I n0ffector Date