HomeMy WebLinkAboutDrain Layers Permit 255 Diane Drive TOWN OF SOUTH WI N DSOR
DEPXRTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
�'u : 0 DRAIN LAYERS PERMIT 5787
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by �ta,2,A�) Sk 1
whose address is and to
Lay Hous Drain, Repair House Drain, Lay,'Main, Other , ,
for 5 occupancy or use, with
Family Unites , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE 'M ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with V
Show sketch of proposed work or furnish two (2) copies of separate drawings.
l
SPECIA CONDITIONS
D)9-1; d "St#-1ting Date 11 Estimated Time for `Completion
t_ Fermat to be issueto E' t'
the holder of Drain Layer's .License No. 7 oZ Permit wil expire thirty
(30) days after date of issuance. The undersignee Drain Layer hereby agrees
to all the- terms and conditions set forth in the _permit and the reYverse side
thereof* applicant has received Town Permit and/or
CHD Permit No.
Signed .
Licensed ra n Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactor "b nd and insurance policy. in the
name of the Town of South Windsor: j
2A
_ Z
n ne g Dept. Date
Permit Fee Paid $ �S„-(�(� Chec Aer Z-5-z
Connection Charge Receipt No. a t e d (aho 9 2-
Issued by
INSPECTION
Date work started �"f ZZ' Date completed
Sufficient notification received : Z7 Yes No
Special Conditions
APPROVED: Z--
Inspectorv, Date