HomeMy WebLinkAboutDrain Layers Permit 200 Carriage Drive ,.., Zl-
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5301
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perforu} the work,tndicated below at �0o
at premises owned by ;�. "% C �r�wlco 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
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Show sketch of proposed work or furnish!7two4'f. 'copies of separate drawings.
1(5TF/ � HOUSSPECIAL CONDITI
Desired Starting Date — 2a— Estimated Time for Completion
Permit to be issued to Sk-i 9S cSF P27CY Z UlCc-- /4k ,
the holder of Drain Layer's License No. 70772 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 side thereof. App icant has r ceived
Town Permit No. and/or CHD Permit No.
Signed
icensed Drai Layer
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:
2
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Engineering Department Date
Connection Charge Paid j/00- Permit Fee: Paid $ /f; '()l)
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
Construction Inspection
Report —,
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Work in Pr�gare
1 •
Problem Areas
Special Instructions ! • .