HomeMy WebLinkAboutDrain Layers Permit Debbie Drive to Part TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 1 6 i
1C910
Pursuant to written application, permission is her grante to the is nsed Drain La e
named herein to perform the, work i icated be w at ���i< Mj44 jy
at premises owned by �, '�'� _ -j C.'F� whoseVaddress is
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 ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to �2�fv �rUSI -C) . XNC
the holder of Drain Layer's License No.7,7—S Z y 3. 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 rec ed
Town Permit No. and/or CHD Permit No.
Signed
icensed Drain L�. r
s' li
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ip the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date