HomeMy WebLinkAboutDrain Layers Permit 71 Berle Road TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL s�
DRAIN LAYER'S PERMIT 0, 4217
19
Pursuant to written application, permission is hereby=; to.the Licensed Drain Layer
named herein to perform the work indicated below at Ay
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 O, 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
Permit tobe issued to
the. holder -of Drain Layer's License No._264 Permit will expir thirty 30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all terms and
conditions set forth in the permit and the reverse side thereof. p ica received
Town Permit No. and/or CHD Permit No.
Signed
Lic s ai ayer
The above named Drain Layer has a valid license issued by the State o Conned icut and
has filed a satisfactory bond and insurance poli the name of the Town of uth Windsor:
/ zef:z� - - 7 -- 6
Engifieering Departmenntt-v Date
Connection Charge Paid 47/ fG Z Permit Fee: Paid $ �J �.5� �f'6
Check N � 5�5 5
Issued by �-
Tax Office
-9
INSPECTION
Data work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate