HomeMy WebLinkAboutDrain Layers Permit 0365 Avery Street ":i.,..� Y° }* - :. Y�' 7^..K. } `t 'i- t ' '' �
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TOWN OF 1,SOUTH Wt N DSOR
DPPAPT14ENT OF PUBLIC WORKS
BURM&U OF POLLUTION CONTROL
DRAIN LAYER'S PERMITo
� 3�Z. e� // ,` 19 04
Pursuant to written apPlication,tpermi�ssion is h r b gran o the Li jensed Drain Layer
named herein toperform the work ind caked below at; --+
at premises owned by (, �;� J� (� ( 1 . whose address is
and to
Lay House Drain, Repair' House Drain, 'Lay Main, Other ,
for : . occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), I1$USTRLAL
WASTES ( ), OR ( ) Connection will be madewith
—T—
Show sketch of -proposed .work`or furnish two (2)' cdpies of sepa"rate drawings.
a t
SPECIAL CONDITIONS'
Desired Starting' Date Estimated Time for Completion,
Permit- to be issued to 4
the holder of Drain_ Layer's 'License No. Permie will empire thirty (30) days �A
after date of issuance The undersigned Drain Layer hereby agrees to all :-tYi04' fermk and
conditions set forth in the permit and the reverse side thereof. Applicant has 'i�eceived
Town Permit No.. and:/or CHD Permit. No.
Signed
:License$'`D in Layer-
..The above name ,.Drain Layer has a valid license issued by' the State'`of Conr.ect'icut and
lias ,filed a satisfactory bond. and insurance Policy In the name of the To of*'Soiith'Windsor:
d o
- - -
ngineQrzng Depart nt ' ate
Connection Charge Paid �ad U Permit` Fee: Paid'$ �V
Check Number
t_ Issued byr.
` Tax Office
i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
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Inspector pate