HomeMy WebLinkAboutDrain Layers Permit 37 Carson Way TOWN Of SOUTH W!N DSOR
® DEPARTMENT.OF PUBLIC WORKS
pf, BUREAU OF POLLUTION CONTROL
C DRAIN LAYER'S PERMIT [114G 5770
9z:
Pursuant to written application, permission is he eby granted to the
L ' censed Drain a r nam d herein to perform the work indicated below, at
4-d 1-17 at r mises,�. j�xan d ,by J � G�NS1•
whose address is i h 501 G(//yt Slope and to
Lay House Drain, Repair Wouse Drain, Lay Main, Other': ,
for occupancy or use, with ,$ r" zf
Family Units, with acres.
Type of Sewage' to be connected under this permit: SANITARY SEWAGE { ,
INDUSTRIAL WASTES ( )' "OR { )
Connection will be made with
Show sketch of proposed work or furnish two (2) copid of se agate drawings.
SPECIAL CONDITIONS
Desired Starting* Date Estimated Time for Completion
Permit to be issu d to
the holder of, Drain Layer's License No o $ Q er it A&ll expire thirty
(30) days after date of. issuance The undersigned Drain L er hereby agrees
to all the terms and conditions set forth in the permit and the reverse side
thereof. Applicant has received Town Permit N � � and/or
CHD' Permit No.
Signed
Lic se Drain Layer
The above named Drain Layer has a valid lice se issued by the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town 'of South Windsor:
E i eer Dept. Date
Permit Fee Paid Check Nu beg �uZ ,
Connection Charge Receipt No. 416 ated
Issued by Z
INSPECTION
Date work started Date completed
Sufficient notification rece ve : 4,7, yes No
Special Condition
APPROVED
Inspector Date