HomeMy WebLinkAboutDrain Layers Permit 56 Bramblebrae TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1Q
19�--
Pursuant to written application, permission is hereby $ anted to the Licensed Drain Layer
named herein to perform the work indicated;belowat. 6 } ` . �y�,
at premises -owned°by S whose address is
and;to
Lay House Drain," ', Repair'Douse 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 O 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. Completi`on
Permit_ to be issued to
the holder of Drain Layer':,s •License No. Permit will expire thirty 0)`'days
after date of issuance. The undersigned Drain Layer hereby agrees to all the' tertns`.and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. , and/or CHD Permit No.
Signed _
F Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State, ot'Connect'icut and
has filed a satisfactory bona and insurance policy in the name of the"Town of toutl Windsor:
r Engineering Department Date
Connection Charge'Paid ydD- 0 0 Permit Fee: Paid' $
-� Check
.4; �47 at Lk-- C2� C '�L Issued by
Tax Offi
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
---— --- APPROVED:
Inspector Date