HomeMy WebLinkAboutDrain Layers Permit 469 Buckland Road .; .,. ,ter.-, ..; _.,� .. ,.. ., .... ......
TOWN ;OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
70
�' A.
DRAIN LAYER'S PERMIT tL 5 2 6
Pursuant to written application, permission is hereby anted to th L' ensed Drain Layer
named herein to perform the work ind' aged low at LI((
at premises owned by r-- . , whose address is
and to
Lay House Drain, Repai House Drain, Lay Main, Other ,
for 1'7 t F1 C occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (I�INDUSTRIAL
WASTES/ ( ), INCR () Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
d � e
SPECIAL CONDITIONS
Desired Starting Date - Q' - Estimated Time for Completion 77
7t ZS
Permit to be issued to 4-f -�C T�f2 CjQ<_s-rj2AC1--1o1,i Cn. , I/Jc•
the holder of Drain Layer's License No. U]7 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 s' e,,thereof. Applicant has received
Town Permit No. !J A- and/or CHD Permit No. W
Signed
j' Licensed rain Layer
i
The above named Drain Layer has a valid licen�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 Char e Paid
g / Permit Fee: Paid $ /J
_ Che�,fNu ber
/ Issued bylG.-
Tax Office
INSPECTION
Date work started �4e Date completed
Sufficient notification received: es No
Special Conditions
APPROVED: w�
Inspector pate