HomeMy WebLinkAboutDrain Layers Permit 17 Bridle Wood Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF. PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT (o). 4794
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\ / / 190
Pursuant to written application, permission is ereb ranted oJthe Licensed Drain Layer
named herein to perform the ork indicated below atf, CA „tom (
at premises owned by : 4 2 whose address 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 O, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
0�_=T75
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion �.r C b.
T�
Permit to be issued to .�
the holder of Drain Layer's License No. z 0 `i Z.- 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 Ahe name,,o� the Town of South Windsor:
t
Eng'neering Depart t Date
Connection Charge Paid Permit Fee: Paid $ `~� J 0
Check Number
Issued by
J Tax Office
INSPECTION
Date work started Date completed 17-IL-g4
Sufficient notification received: Yes No
Special Conditions . �.(Cwv,t.lrEWP,�
APPROVED.
Inspector Date