HomeMy WebLinkAboutDrain Layers Permit 393 Deming Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
-- 19 ,'j
Pursuant to written application, permission is herebyranted to the Licensed Drain Layer
named herein to perform ,the work_indicated below at j T
at premises o ed by ,$ 1 i;J whose address is
irk 11( t WOO.t v , . ': _ .��. �1 i f�V ot1 C� and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE �<), INDUSTRIAL
WASTES ( )1j R ( ) V Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
Gil
SPECIAL CO ITIONS C�--------- - - ---
Desired Starting Date :<< tt � ("� `� Estimated Time for Completion ( &&p
Permit to be issued to
the holder of Drain Layer's License No. ZA-7 H�j 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 1 r
4
Licensed' ain Layer
The above named Drain Layer has a valid license 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 Department Date
Connection Charge Paid ` 3
g Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started ?1 Date completed
Sufficient notification r ce' ed: p/ Yes No
Special Conditions
APPROVED: r
Inspector" pat
d
Construction Report
Developer
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EWA
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y
Construction Inspection Report
Project ' Dole
or,.. .
Stre Time 1 d
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Weather In
Developer Contr cto
a
Work irMrogress
Problem Areas
Special Instructions/Orders