HomeMy WebLinkAboutDrain Layers Permit 113 Beelzebub Road sqt: fis4' t'Q' ,
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT *v)- 5 6 2 s.
f 19 "7
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at L1
at premises owned by L�r r0" ( ,� " ,�,�} c�, whose address is
/o r < and to
Lay House brain, E !Repair House Drai , Lay Main, Other ,
for .F•�a % fG,�7 /� -4,f� occupancy Or use, with
Family U its, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (l), INDUSTRIAL
WASTES ( ), OR O Connection will be made with
t?
Show sketch gf proposed work or furnish two (2) copies of separate drawings.
l
1 �
SPECIAL CONDITIONS
Desired Starting Date / / Estimated Time for Completion
Permit to be issued to 1i�Gi2!J r' �e n rZ < i - <;_•✓-'s,. �,,,�
the holder of Drain Layer's License No. Z 76, 0,0Permit will expiri thirty (30) stays
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 7-ZA,
Licensed D a`iX Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
trB Engineering Department Date
Connection Charge Paid ': r Permit Fee: Paid $ l�-
Check Number
Issued by
Tax Office
INSPECTION
Date work started ! Date completed /— 1 7-21
Sufficient notification received: es No --T
Special Conditions
APPROVED•
Inspector Date