HomeMy WebLinkAboutDrain Layers Permit 31 Bissell Court TOWN OF SOUTH WIND
SOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NG 5671
O
C'�L ( 19-&
Pursuant to written application, permission is hereby ranted to the Lice sed Drain Layer
named herein to perform the work indicated bela at
at premiseg, wne by AJA whos address is
IA I Drain and to
Lay House , Repair House Drain, Lay Main, Other
for ,
occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit:
WASTES ( ), OR ( ) p SANITARY SEWAG ( ), INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of 4sepaate drawings..
Cole
SPECIAL CONDITIONS
01
Desired Starting Date / Estimated Time for Completion GU,C
Permit to be issued to 15e--06=-�70AI&��
the holder of Drain Layer's License No. 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; �ain 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:
g" ee 'ng Department Date
Connection Charge Paid -1f- 169 Permit Fee: Paid $
Chec Number
c0-
�Q
Tax Q�f f is e Issued by
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate