HomeMy WebLinkAboutDrain Layers Permit 024 Austin Circle TOWN OF SOUTH WlNDSOR
DEPARTMENT OF."PU$LIC WORKS
BUREAU OF.POLLUTION CONTROL
DRAIN LAYER'S PERMIT g"' 5833
191�
Pursuant to written application, permission is ereby granted to the
Lice' sed Dra,Waver named herein to perform the work indicated below/ at
g at premises owned by J /?ij„j GCjFj
whose a ess is 6S'$ iF
� S0� an o
Lay Douse Dry in, repair House, Drain, Lay Main, Qth- r ,
for - occupancy or use, with $�
Family nits with acres.
Type 'o.f' Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) OR' '(
Connection will. be made with $" E
Show sketch of proposed work or furnish two (2) copies of separate drawings.
F
1.'SPECIAL CONDITIONS
�, 1�ar'
] Y''��r(J/j9 Pjr �y`yS.
Desired S arting Date Estimated Tine for Completion,
Permit to be issued to 30 61 Jcr Chu
the holder of Drain Layer's License No.. cQg n'30.' Permit will .ex.pire thirty.
(30) days after date of issuance, The unde-rsigned 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. /zf�,;� and/or
`CHD Permit N'o.
Signed (�..
icensed ain ayes
The above named Drain
-Layer has a vali, iaense 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 Dept, Date.
Permit Fee Paid $ Check Number
Connection Charge Receipt No. .�./ z;4 Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification receive es No
Special Conditions
AP
Inspector Date