HomeMy WebLinkAboutDrain Layers Permit 617 Clark Street hi TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT P
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at /,/,O 'I t ate,_
at premises owned by whose address is
r
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 ( ), 0 ( ) Connection will be made with
7
Show sketch of proposed work or fu ish two (2) copies of separate&=V
f9 ---_ _
SPECIAL CONDITIONS
Desired Starting Date — Estimated Time for Completion Y1YpTT1
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby .agrees to all theterms and
conditions set forth in the permit and the reverse 'sidd thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
-Licensidd Drain Layer
The above named Drain Layer has .a valid licet�de issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in he name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid L -�L',C%U Permit Fee: Paid $ [�U
- Check Number
l�
Issued by
Tax Office
INSPECTION
Date work started - ' — Date completed — �J
Sufficient notification eceived: Yes `No
Special Conditions ,;;
APPROVED: ,r
Inspector Dafdr