HomeMy WebLinkAboutDrain Layers Permit 25 Bidwell Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19f
Pursuant to written application, permission is hereb �$rantgd to, he censed Drain Layer
named herein to perform the Jdork ind'catedelow atJ ��tr
at premises owned by f, a r+r Co whose address is
✓(„� v�` and to
Lay Housetrain, - Repair House Drain, Lay Main, Other
for ,, ;�'LC r C �� occupancy or use, with
Family Units, with / acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (A), INDUSTRIAL
WASTES OR ( )
Connection will be madewith
Show sketch of proposed work or furnish two (2) copies of separate drawings.
IZ
' , --
SPECIAL CONDITIONS f 0 S S o U-P (' f
Desired Starting Date J,,L Estimated Time for Completion
Permit to be issued to �(A ,7,z !'
the holder of Drain Layer's License No. arj Permit will expire thirty (30) days
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.
SignedLicensed 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:
Engineering Department Date
Connection Charge Paid'' "r Permit Fee: Paid $
Checkk Number i
Issued by
Tax Office
INSPECTION
Date work started Date completed 7 —/y "7/
Sufficient notification received: Yes No
Special Conditions
APPROVED: 7�w
Inspector pate