HomeMy WebLinkAboutDrain Layers Permit 34 Elderberry Lane k Y. .: 1
'12
TOWN OF ` SOUTH WtND50R
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION;CONTROL
. o 5878
DRAIN LAYERS PERMIT N.
Pursuant to "written application, permission is hereby granted to the
f Licensed grain Layer named herein to perform the work indicated below at
vf- y at premises owned by ui 4' 4 =
whose address is O ,(ZT w f2 .Cu rs44 and to
Lay House Drain, , Repair House Drain, Lay Main, Other . ,
for occupancy or use, with
Family Units, with acres.
Type of 'Sewage to be connected under this permit : SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR. )
Connection will be made with
Show sketch of proposed work or furnish two (2) co'pies 'of separate drawings,
1
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer ' s License No. 5 Permit will expire thirty
(30) ; days after da.te ..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.
S i g rf e d
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 Pn the
name of the Town of South Windsor :
.57
Engineering Dept._ Date,:
Permit Fee Paid $ ' Check Number d / 46,
Connection Charge Receipt No, � .��.� Dated ���,1�--� Z
Issued by
INSPECTION =
Date work started �� '��-- Date' completed.
Sufficient notification rec elveTc': yes No
Special ,Conditions
APPROVE D.
inspector Date-,