HomeMy WebLinkAboutDrain Layers Permit 0735 Avery Street ::. .
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��TT
DRAIN LAYER'S PERMIT A�N(,)o, 4926
A0 , 19j
Pursuant to written application, permission is hereby ranted to the Lice sed Drain Layer
named herein to perform the work indicated below at
at premises owned by 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 wolk or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated T me for Completion
Permit to be issued to �-,��
the holder of Drain Layer's License No. a Permit will expire thirty (30) days
after date of issuance. The undersigne Drain Layer hereby agrees to al, the terms and
conditions set forth in the permit and the reverse side thereof. ; pl nt has received
Town Permit No. and/or CHD Permit No.
Signed
Lic used in Layer
The above named Drain Layer has a valid license issued by the �of Connecticut and
has filed a satisfactory bond and insurance policy a name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 7('Z� Permit 'Fee: Paid $
Check Number 's ?j
Issued by
Tax Of f ice
INSPECTION
Date work started ® Date completed �Q --�—
Sufficient notification received: _ Yes No
Special Conditions
APPROVED:
Inspector pate