HomeMy WebLinkAboutDrain Layers Permit 104 Carriage Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT' , Q 2
2 - 1x- S
Pursuant to written application, permission is hereby ranted to t Licensed Drain Layer
named herein to. perform,the work indicate . below<a - AO' a --z
1
at premises owned by 61 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 Kl�be
INDUSTRIAL
WASTES O, OR ( ) - Connection wi made with
Y
Show sketch of proposed work or furnish two `(2) 'copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date w-' - Estimated Time for Completion
Permit- to be issued to
the holder of Drain Layer's TIcense No. Peermit w3,ll ex ire th 'rty' (30) days
after date of issuance. The undersigned Drain Layer hereby agre s to he terms and
conditions set forth in the permit and the reverse side thereof " p is t has received
Town Permit No. and/or CHD Permit No.
Signed AI
is rased n Layer
The above named Drain Layer has a valid license issued by a S.t a-tif Connecticut and
has filed a satisfactory bond and insuranc 1 cy.`in the name a down of. South Windsor:
Engineering Deparlmlint. Date
Connection C ge Paid ;2 Z( Y Permit Fee: Paid $
Check Number ? ,
Issued by
ax Office
INSPECTION
Date work started Date completed
Sufficient notification, received: Yes No
Special Conditions
APPROVED:
Inspector Date