HomeMy WebLinkAboutDrain Layers Permit 15 Bluleberry Circle TOWN OF SOUTH WI N DSOR /
DEPARTMENT OF PUBLIC WORKS �����cbe��y �.•.
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Ito, 4495
1949
Pursuant to written application, permission is her b gg.nted to the Licensed Drain Layer
named herein to perform the work indri.cate below at 7-" /5-
at premises owned by
whose address is
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: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), 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 to be issued to - - a:� -7-". o
the holder of Drain Layer's Licen a No. Z,p£r Zz- , P rmit will expire thirty (30) days
after date of issuance. The under igned Drain La ereby agrees to all the terms and
conditions set forth in the permit and-�- ._ se side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed 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:
ngineering Department Date
Connection Charge Paid ' r� lv Yl7r Permit Fee: Paid $ /L
IFL
< , Check Number, Z-_.
Issued by .
i
Tax Office
f
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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