HomeMy WebLinkAboutDrain Layers Permit 34 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo, 4901
19 �
Pursuant to writtenapplication, permission is her* gr nted to the Licensed Drain Layer
named herein to perform the work indic ted below at � l-
at premises owned by whose address 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 Est' ated Time for Completion
Permit to be issued to , �/ .i ) ,p
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigne Drain Layer hereby agrees to all the erms and
conditions set forth in the permit and the reverse side thereof. A7p * nt h received
Town Permit No, and/or CHD Permit No.
Signed
Licensed Dra Layer
The above named Drain Layer has a valid license issued by the t �eof onnecticut and
has filed a satisfactory bond and insurance policy in the name of t e Town of South Windsor:
Ll 76--
Engineering Department Date
Connection Charge Paid (f �� Permit Fee: Paid $ 1 i
Check Number /1
Issued by
Tax @ffice
INSPECTION
Date work started � `24—z? Date completed
Sufficient notification received: e�-' Yes No
Special Conditions
APPROVED:
Inspector Date