HomeMy WebLinkAboutDrain Layers Permit 250 Diane Drive _. _. :., :•. :,..., ..::;t .Q^.Pij(_,y.,a,..g:"''t4.. ..y`if }O: _.. ", rm't _ ..
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT s � 5670
19
Pursuant to written application,pp , permission is hereby granted to the ce sed Drain Layer
named herein to perform the—yor indicate below at 2
at premises owned b --
Y f � L'/(; i-�f" whose address is
and to
Lay House Drain, �f. 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 (/)1"'INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
J
Show sketch of proposed work or furnish two (2) copies of separate drawings. ` -
n. L'
SPECIAL CONDITIONS--
Desired Starting Date -j � / i
Tom,,, 7 , Estimated Time for Complet'on
Permit to be issued to //,Z _ a�
the holder of Drain Layer's License No. _,�7c�- Permit ill expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the erms and
conditions set forth in the permit and the reverse side thereof. A 'a#t as received
Town Permit No. and/or CHD Permit No.`
Signed
Lic V
n 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 Separtment Date
Connection Charge Paid 6016- , Permit Fee: Paid $ may'
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date