HomeMy WebLinkAboutDrain Layers Permit 170 Benedict Drive �\1Z
TOWN OF SOUTH W N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5405
Pursuant to written application, permission is hereby granted to the L ensed Drain Layer
named herein to perform the work indicated below at / Q C;,, . L,,c
at premises owned by � E, ,i 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) copies of separate drawings.
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SPECIAL NCO DITIONS
Desired 'Starting Date Estimate Time fo Completion ^r; S
Permit to be issued Zo �7_ �.J
the holder of Drain Layer's License No. C�; ermit will expire th'rty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to �l he terms and
conditions set forth in the permit and the reverse side thereof. Ap i�a t has received
Town Permit No. and/or CHD Permit No.
j,.
Signed
Lic nse-.Dr in Layer
The above named Drain Layer has a valid license issued by th4�te of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineefing Department Date
Connection Charge Paid ? �II c
g 1 Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION ` J
Date work started 3 -` •-9Z G/ Date completed
Sufficient notification rece ed: _ yes No
Special Conditions
APPROVED:
Inspector Date