HomeMy WebLinkAboutDrain Layers Permit 28 Elderberry Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 5796
-- aul'e 2 Y_ 19—�211—
Pursuant to written application, permission is hereby granted to the
Licensed rain Layer named herein to perform the work indicated below at
at premises owned by �G�,
whose address i6 '
r�7 G�J �4 T�wti ,o✓) and to
Lay House Drain, Repair House Drain, ay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE (k) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with -u) C
Show sketch of proposed work or furnish two (2) copies of separate drawings.
c t�1 br. S
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer IsLicense No. C>J? Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions oet forth in the permit and the reverse side
thereof. Applicant has received Town Permit No . and/or
CHD Permit No.
Signed
Licensed Drain 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 Dept. Date
Permit Fee Paid $ Check Number $Cq G
Connection Charge Receipt No. _ P Q Dated �a
Issued by
INSPECTION -
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROVED:
Iiispector Date