HomeMy WebLinkAboutDrain Layers Permit 111 Birch Hill Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at /// 84C H t/iL L 18 f
at premises owned by R013ERT °J-LtJCy 1 G�{/�Gr✓/ whose address is
/// /psi C79 f/ii L t)/' • and to
Lay House Drain, )C 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 W, 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 CONDITIONS
Desired Starting Date /0- -2 4 - Estimated Time for Completion 1C) - > > -._
Permit to be issued to t��1� ��I �� y
the holder of Drain Layer's License No. 7 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.
Signed
Licensed Drain , yer
The above named Drain Layer has a valid mkngine�rin)z
' by the State of Connecticut and
has filed a satisfactory bond and insurance pinme a Town of South Windsor:
Department Date
Connection Charge Paid Pe mit Fee: Paid $ a v U
Check Numberi\ W 7 L�
Issued by
Tax Office
INSPECTION
Date work started Date completed
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Sufficient notification receiv d: Y s No _
Special Conditions
APPROVED;-
Inspe for pa e