HomeMy WebLinkAboutDrain Layers Permit 0490 Avery Street A.
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 6 o 2
19L�
Pursuant to written application, permission is here�jby gra ted to thp) 4icensed Drain Layer
I
named herein to perfoM--�th woKk i7d'cate( b ow at D
at premises owned by VA
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 INDUSTRIAL
WASTES OR Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
17
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No-L)Cj) /_& Permit will expire t rj�,;_j 9, (30) days
after date of issuance.' The undersig&d/d Drain Layer hereby agrees al thd//terms and
conditions set forth in the permit and the reverse side thereof.
li nt s received
Town Permit No. and/or CHD Permit No.
Signed
ens t/lIvAirF179-y .r
The above named Drain Layer has a valid license issu Zdby Athe Sta nnecticut and
has filed a satisfactory bond and insurance policy in the name of th Tof Soixth Windsor:
4
/tngii-Bering—Dep!artment Date
Connection Charge Paidl—JLL Permit Fee.-- Paid
Check Number
1 �f A -A Issued, by
)4, /j Tax Offi66 '
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date