HomeMy WebLinkAboutDrain Layers Permit 2250 Ellington Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT q 516
Pursuant to written application, permission is hereby granted t the icens�j Dra3'� Layer
named herein to perform a work in icate below a 7 �yj� q
at premises owned by ( � � � L whose address is
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 (X INDUSTRIAL ����J
WASTES ( ) OR ( ) Connection will be made with /(
Show sketch of proposed work or furnish two (2) copies of separate drawings.
"C nisot
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer heXce
s to all the terms and
conditions set forth in the permit and the reverse sideApplicant has received
Town Permit No. and/or CHD Permit No. /
Signed 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 the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid _ Q— Permit, Fee: Paid $
Check Number 43c2G /7 CG
Issued by
Tax Of f is
INSPECTION
Date work started Date completed
Sufficient notification received: s No
Special Conditions
APPROVED: -!'i -.
Inspector Date