HomeMy WebLinkAboutDrain Layers Permit 038 Carriage Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
a
DRAIN LAYER'S PERMIT Xo, 5098
lO 19k
Pursuant to written application, permission is hereby grant d to the Lice se Drain Layer`
named herein to perform the work indicated Belo t ry
at premises owned by whose ((ddress 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 t is e it• SANITARY SEWAGE (019 INDUSTRIAL
WASTES ( ), OR ( ) /J � �� ) Connection will be made with
Show sketch of proposed work or furnish two" (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion -7�3-- g
Permit to be issued to J,r G.
the holder of Drain Layer's Licenbe No.,p ZA t S-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 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 policy in th name of the Town of South Winds r:
Engineering Department D ak e
Connection Charge Paid oge Permit Fee: Paid $
Check Number Q
Issued by
Tax Office
INSPECTION
Date work started t -
�0 (p `0O Date eted (1 7, 9
Sufficient notif is ion received: Yes N �
No
, Special Conditions
APPROVED: r
Inspector a`
Construction Inspection Report
Project 4P _pADate X
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Time41
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Weather 2` D o f' I
Developer Contract r
Work in Progress /J
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Problem Areas
Special Instructions/Orders
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