HomeMy WebLinkAboutDrain Layers Permit 168 Debbie Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF:PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X0. 4246
l�8 AGp- 4L
19
Pursuant to written application, permission is h reby gr n to/,the Licensed Drain Layer
named herein to perfo -h work w;;, indic7ted pelo at �,;° f � t d -
at premises owned by
whose address is
Lay House Drain, Repair House Drain, La Main and to
for y , Other .
Family Units, with occupancy or use, with
acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ),WASTES ( ), OR ( ) INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
Ga i
SPECIAL CONDITIONS ,
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No
ermit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the4Lay
conditions set forth in the permit and the reverse side thereof. pplicant h
Town Permit No. and/or CHD Permit No.
`. Signed
icensed Drain
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy, the name of the Town of South Windsor:
4/1- 27-
Engineering Department Date
.Connection Charge Paid �j-/ k��'` �� -=�- �
�/0 Permit Fee: Paid $ J LJ J
` Check Number
1, Lam.. Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date