HomeMy WebLinkAboutDrain Layers Permit 0454 Avery Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a} 5 C zi
s
f 19 ,,.
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work, indicated below at � A[l
at premises owned by '' � �', ag1��' , whose address is
v f and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for [ ,f , (,� �� , occupancy or use, with
Family Units, with ZsZ acres. C
Type of Sewage to be connected under this permit: SANITARY SEWAGE (,./)/$ INDUSTRIAL
WASTES ( ), OR ( ) �< /py C_ Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS ---
Desired Starting Date Clu Estimated Time for Completion 7
Permit to be issued to C�v U
the holder of Drain Layer's License No. �^7 G��r 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. ` �P�ji ant has received
Town Permit No. and/or CHD Permit No.
Signed ,
cen .ed.Drain Layer
The above named Drain Layer has a valid license issued by e-'State of Connecticut and
has .filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ 7i1�
Check Number
Issued by
Tax Office
INSPECTION
Date work started -�-9C� Date completed�'1
Sufficient notification received: _des No
Special Conditions
APPROVED: _
Inspector Date