HomeMy WebLinkAboutDrain Layers Permit 819 Clark Street ' TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT -421 51,6
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Pursuant to written application, permission is hereb t d to the Lice �d Drain La Tr
named herein to perform the work indicated below at -LI -� -�- ��_ ��yU� ,� �)
at premises owned by whose address is
Lay House Drain, and to
for k Repair House Drain, Lay Main, Other ,
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE OC), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawin s.
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SPECIAL CONDITIONS
Desired Starting Date iU Z Estimated Time for Completion y In4l's
Permit to be issued to ---U- /V �44/1� i2
the holder of Drain Layer's License No. 410 37 . 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 1,r� ,.�,)ti'�Joa � S<i%c T,ti/I Go 1"�Jt
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 policyn�te nameVhe Town of South Windsor:
Eriginee i Department Date'�—
Connection Charge Paid �d /e � `t�'86 per it Fee: Paid $ 2:S
Cieck umber
Issued by
Tax Office
l �
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date