HomeMy WebLinkAboutDrain Layers Permit 125 Burgess Road TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT t i N2 5427
H- l o 1 99� J
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer
named herein to perform the work indicated below at )TF 6u,�,fe" a L.
at premises owned by v�SSe1` whose address is
and to
Lay House Dr n, Repair House Drain, Lay Main, Other
for I=cz Y. 0 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.
66
f� �i y)N
fi, F<�rfGU (See approved site change-
Susan & Russell Peterson
Single Family Home -88-110W)
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
r
Permit to be issued to Yod V
the holder of Drain Layer's License No.= 9H . Armit wi 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 Ain Layer
The above named Drain Layer has a valid lic se issued by the State of Connecticut and
has filed a satisfactory bond and insurance poli i the name o e Town of Sout Wi dsor:
E inee Department Date
Connection Charge Paid Perm t Fee: Paid $
C eck umber
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date