HomeMy WebLinkAboutDrain Layers Permit 0420 Avery Street TOWN OF SOUTH WI N DSOR
'DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 26
, 19b �
Pursuant to written application, permission is hereby granted to a Ub - Licensed Drain Layer
named herein to perform'twork indicated below at i/ 1� ti u
at premises owned by ,E ,-ez:.� L 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 conpected under this permit: SANITARY SEWAGE ( ; INDUSTRIAL
WASTES ( ), OR ( ) ;� V Connection will be made with
r
Show sketch of proposed work or furnish two (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 thirty (30) days
after date of issuance. The undersigned Drain Layerhereby 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.
SignedyGv,
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in-thename of the Town of South Windsor:
Engineering Department Da
Connection,
Charge Paid Permit Fee: Paid $ ).
Check Number
NA") ' Issued by
Tax Office
INSPECTION
Date work started rlj--2 �j� Date completed S�Z 7
Sufficient notification received: s No
Special Conditions
APPROVED:
Inspector Date