HomeMy WebLinkAboutDrain Layers Permit 1060 Avery Street Y • TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 16 C
Pursuant to written application, permission is hereby granted tot Licensed Drain Layer
/,.A
named herein to perfor-%, the worts indicated below at
at premises owned by f_, i ��. . ,u -� f�; 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) co ies of e ra
- te drawings.
�2c�"T"' --- �`- - ----
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to A , Z:�) C . c
the holder of Drain Layer's License No. 2 U 91 td/ 7j . P6fmit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the term nd
conditions set forth in the permit and the reverse side thereof Applicant has r c�ived
Town Permit No. and/or CHD Permit No.
Signed
icensed Dr i L er
The above named Drain Layer has a valid license i sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ' th name of the Town of South Windsor:
a �
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ / ` -06)
Check Number
Issued by
Tax Office
i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
ex, BUREAU OF POLLUTION CONTROL
A 1)4
Y DRAIN LAYER'S PERMIT No.
, 19?
Pursuant to written application, permission is hereby anted to the Licen 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 de with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
I
SPECIAL CONDITIONS
Desired Starting Date Vstimated ime fo Comple i n
Permi to be issued to
the holder o Drain Layer's LLder
ense No. ermi will xpire thirty (30) d y
after date of 'ssuance. The signed D in L er ere y a re s to all the terms and
conditions set orth in the pe it and the revers ide thereof. Applicant has recei ed
Town Permit No. an /or CHD Permit No. �i� y' fL
Si ed
Licensed Drain Layer
The above named Drain ayer as a valid license issued by the State of Connecticut and
has filed a satisfactory bon and •nsurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
a
Check Number
Issued by
Tax Office ,
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date