HomeMy WebLinkAboutDrain Layers Permit 52 Connecticut Avenu :TOWN OF SOUTH #WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4633
19 i
Pursuant to written application, permission is hereby &ranted to the Licensed Drain Layer
named herein to perform the work ind'cated below at C4_1__
at premises owned by whose address is
and to
Lay House Drain, Repair HouseDrain, 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 ( ), OR ( ) 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
Permit to be issued to
the holder of Drain Layer's License No. 7Zp7 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 as eived
Town Permit No. and/or CHD Permit No. �
Signed ;`,(,��/lf�Ce�/ ,✓%�-'�
i LicensgT Drain Layer
The above named Drain Layer has a valid licen�se' issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy -in the name of the Town of South Windsor:
7
Engineering Departm nt Date
Connection Charge Paid o`, (2 ` L� , Permit Fee: Paid $ / S
Check Number
C L" r' Issued byJ '
' Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date