HomeMy WebLinkAboutDrain Layers Permit 159 Benedict Drive TOWN OF SOUTH WINDSOR �-� �j s�
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 4487
/7f
Pursuant to written application, permission is hereby granted to theLicensed Drain Layer
-,
named herein to perform- the work ' dicated below at
at premises owned by address is
�9 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
1� — N I .
Permit ',to be issued to _L d.�,,-J) /_�J IS/4'4110,sk ,
the holder o�Drain Layer's License No. Permit will expire thirty (30) days
after d t of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditio : set forth in the permit and the reverse side thereof. Applicant rec
eived
ceived
Town PeNt No. and/or CHD Permit No.
Signed
Licensed Drain 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:
fengineering Depj%r�ment Date
Connection Charge Paid Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification receivecl;_ Yes No
Special Conditions e
APPROVED: /7-
Inspector Date