HomeMy WebLinkAboutDrain Layers Permit 18 Bissell Court / TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL A
DRAIN LAYER'S PERMIT « 0 5784
19�
Pursuant to written application, permission is hereby granted to the
Lice;sed D a.in- Layer named herein to perform the work indicat d below at
?° a J� at premises owned by
whose address is o� and to
Lay House Drain`, Z. Rep r 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 e .33—
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion S/p
Permit to be issued to
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
91 z4L
Licekis-e-d—Draifi 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:
En ne ring Dept. Date
Permit Fee Paid $ 2 �� Check Number Iwo
Connection Charge Receipt No.
Issued by
INSPECTION
Date work started ate completed
Sufficient notification v'yes No
Special Conditions
APPROVED: 12
Inspector Date