HomeMy WebLinkAboutDrain Layers Permit 259 Brookfield Stree s�- TOWN OV OUTH WINDSOR
C DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NOV
3737
/ 19�—
Pursuant to written application, permission is hereb granted to the L c n ed Drain Layer
named herein to perform the wo k in imaged below at
at premises `owned by _ Lul 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 ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will. be made with
Show sketch of proposed :work or furnish two (2) copies of separate drawings. '
i
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit_ to be issued "to
the holder of DrAn'. tayer's' 1icense No. Permit will. expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees `to all the tdkms and
conditions set forth in the permit and the reverse side thereof.. Applicant has received
Town Permit No. .,and./or CHD Permit No.
Signed -
Liaensed Drain Layer
The above na.¢p .Pxain Layer has a valid license issued by the .State` of Connecticut and
has filed a satisfactory bond and insurance policy 3n the name of the Town of Sodth:Windsor:
Y,3 a� � � '� � - All
7
Engineering Department Tate
Connection Charge Paid dO Permit Fee Paid $ 0
Check Number
Issued by
,r--L2
ax Off iF/ef
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date