HomeMy WebLinkAboutDrain Layers Permit 14 Avonwood Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT $ 3760
19LY
Pursuant to written application, permission is er -by granted to the Li nsed Drain Layer
named herein to. perfo h wor in icate .below at.: Q : ��» U011 L1)/9 d : ►J} '
at premises owned. by . �x`: aO a.kA r whose address is
.and,-to
Lay House Drain, 'Repair'H use -Drain, 'Lay' Main,' '` - Other ,
for occupancy or u� se with::'
Family Units, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ) INDUSTRIAL
WASTES ( ), OR.:.( ) Connec.trion will be.made;with
Show sketch of proposed work or furnish tko (2) copies of separate drawings
SPECIAL CONDITIONS
Desired Starting Date Estimated ,Time ,for Completion_`
Permit- to be issued to - .
the holder of Drain'Layer's License, No.. Permit 'will expire 'thix'ty (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. ;.: and/or CHD Permit No.
;Signed
Lieefsed::.Drain Layef
The above named Drain Layer has a.valid license"issued by the 'Staie'of `Co' cticut and
has filed a satisfactory, bond and insurance polioy, in' t a name of the Town of` South.Windsor:
Al-
Engineeringep Darture •t .Date
r %
Connection Charge Paid $�j �� c� j 'Permit Fee: Paid $ D
Check Number
, � Issued by
Tax Office ;
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date