HomeMy WebLinkAboutDrain Layers Permit 77 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ,J1 y E
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at i 1_��-►,y,i',- j_a r IV C
at premises owned by Vy,\ p 7 ;j I c `, whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for I f < !t, occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE Vr, INDUSTRIAL
WASTES ( ), OR ) Connection will be made with
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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
1
Permit to be issued to A
the holder of Drain Layer's License No. 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
T� icensed -Rfain Layer
The above named Drain Layer has a valid li en a issued by the State of Connecticut and
has filed a satisfactory bond and insurance pol iyi 'n the na e f the Town of South Windsor:
EngA ing Department Date
Connection Charge Paid ` -��y�'� P mit Fee: Paid $
h�, k Number -1k
Issued by r
Tax Office
INSPECTION
Date work started _ Date completed &,4Z 2 Z
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector p e