HomeMy WebLinkAboutDrain Layers Permit 814 Burnham Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4436
OP
19
Pursuant to writtk application, permission is hereby grantedIto the Licensed Drain Layer
named herein to perform the work indicated below at / t.7`j },���.,��.��;_ ,I
at premises owned by �� ,�;,�ar' ��.�; , whose address is
4 v,T '
_ and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with LX
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE 91 INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
q 2 -
SPECIAL CONDITIONS
Desired Starting bate Estimated Time for Completion
Permit to be issued to l
the holder of Drain Layer's License No. Q Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth he 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 poli In the tame of the Town of South Windsor:
Eriginee'ring Depar Vment Date
Connection Charge Paid Permit Fee: Paid $ /`
l Check Number
f` /3 Issued b y
Tax Office
INSPECTION
Date work started /lis -7/�/b4— Date completed
iSufficient notification received: Yes No
Special Conditions
i
APPROVED:
Inspector Date