HomeMy WebLinkAboutDrain Layers Permit 154 Commerce Way �- TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Vrn57 38;
z- 19r U
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perfo the work ind'cated below at �� w ';
at premises owned byCj✓ ', �{ whose address is
/S and to
Lay House Drain, Y, 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 t->, INDUSTRIAL
WASTES ( ), R ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
G , S
_. SPECIAL CONDITIONS
Desired Starting Date / Z Y- YO Estimated Time for Completion
Permit to be issued to �j � _� jJ /✓S%/Z�ICi/O�✓ �J. , ��C.
the holder of Drain Layer's License No. Z4-17W 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 s-i:e thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
i
Signed: 7 / r'-
/ i Licens"ed,Drain Layer
The above named Drain Layer has a valid licen/ issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering DeparfAgkrf Date
Connection Charge Paid-O Permit Fee: Paid $
Check Number e�R
Issued by
Tax Office
INSPECTION q
Date work started — 2 �~/d Date completed
Sufficient notification rec ived: Yes No
Special Conditions
APPROVED: ,
Inspector pate