HomeMy WebLinkAboutDrain Layers Permit 19 Blueberry Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4571
_
19,
Pursuant to written application, permission is hereby granteA to the Lice ed Dra yer
named herein to perform_•the work, indicated below at k / , 10
at premises owned by RioL- 0 0 rows_ whose addres is
and to
Lay House Drain, 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 Z ' G $ '7 Estimated Time for Completion ^c - - lc-7
Permit to be issued to JLJj1L o�rs7: CO-
the holder of Drain Layer's License No. Z or z 2G 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 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:
Engineering Department Date
Connection Charge Paid -�/Qd:Ct d Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date