HomeMy WebLinkAboutDrain Layers Permit 0779 Avery Street TOWN OF SOUTH WI N DSOR 7>�
DEPARTMENT OF PUBLIC WORKS
BUREALLUTION CONTROL
DRAIN LAYER'S PERMIT *}
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Pursuant to written application, permission is hereby gra ted to th Licensed Drain Layer
named herein to perform the work indic ted below-at., �. �__
at premises owned by LzCJ - f- a-I i` , `i: whose address is
and to
Lay House Drain, Repair House 'Drairi '- 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.
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SPECIAL CONDITIONS ' fir =' �J�iJ S sL f
Desired Starting Date Est'znated Time for Completion 6 Lo/
/
Permit to be issued to �--
the holder of Drain Layer's License No. 207 t 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. Applicant has received
Town Permit No, and/or CHD Permit No.
Signed
Licensed ain Layer
The above named Drain Layer has a valid license 'ssue�d by the State of Connecticut and
has filed a satisfactory bond and insurance policy in a name of the Town of South Windsor:
tnfiifteering Department Date
Connection Charge Paid Permit Fee: Paid $ C)U
Check Number /f
Issued by
Tax office
INSPECTION
Date work started ��Z��� Date completed
Sufficient notification recei ed: des No
Special Conditions
APPROVED: G 2
Insp or pate