HomeMy WebLinkAboutDrain Layers Permit 1395 John Fitch Boul OWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO, 5203
I �
, 19
Pursuant to written application, permission is here y � an d to the Li nsed Drain Layer
named herein to perform the w, rk indicated below at
at premises owned by r 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 ( ) �7 Connection, rwill�(b1e- made with
CONC T 14N 2� `t 'P14L S-bQ �- Y l P `g�1 W�'4l� �1 Aw Cbl�S fo �D tC bLOS
Show sketch of proposed work or furnish two (2) copies of separate drawings.
.5rC ��pa.t LU 1146
i z - g
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion / o,./ 40offsR
Permit to be issued to (jo C,- - r,4 wit: y. jV 664-6
the holder of Drain Layer's License No. 2y-j 22-Zq . Permit will expire thirty (3 ) 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.
Si ed
icensed Drain ayer
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 the name of the Town of South Windsor:
E ineerin De `g g p artme nt Date
Connection Charge- PaidCf� 6�U ��� Permit Fee: Paid $
Check r
�! G
(� Issued by _4,,�
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date