HomeMy WebLinkAboutDrain Layers Permit 16 Blueberry Circle TOWN OF SOUTH WINDSOR
' DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNb, 5020
- 0 , 19d7
Pursuant to written application, permission is hereby granted to he Licen ed Drai
named herein to. perform the work indicated below at �gryer
at premises owned by hose address is
La House Drain and to
y Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
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.
f
I Pcop,
lo
SPECIAL CONDITIONS loT
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.1 00 g�a h 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
:T 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 i h name of the Town of South Windsor:
L 4?
Engineer ng Departmen Date
Connection Charge Paid - �D�bL7 Permit Fee: Paid $ c6J
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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