HomeMy WebLinkAboutDrain Layers Permit 2304 Ellington Road TOWN OF SOUTH WINDSOR
~ - DEPARTMENT OF PUBLIC WORKS
` BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 5-0 4 1
2 2 19.
Pursuant to written application, permission is hereby granted to the Lice d Drain Layer
named herein to perform the work indicatecrbelow at 2- cl y
at premises owned by whose address is
S rv� and to
Lay House Drain, p/' 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 (a/$ INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
i
Show sketch of proposed work or furnish two 2 copies of separate drawings.
SPECIAL CONDITIONS L' y S v � w
Desired Starting Date 2 -- -2- S"'- k Estimated Time for Completion
Permit to be issued to r._ Gj lti e f�. . /Iu G,
the holder of Drain Layer's Licen a No. o g o s/ Permit will expire thirty (30) days
after date 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. �^
Signed
License rain 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 Depa ent Date
Connection Charge Paid j Permit Fee: Paid $
Check Number 2 5'
/ Issued by � �Lt
/17 Tax Office C
INSPECTION
s'- Date work started B
Date completed
= Sufficient notification received: es No
Special Conditions
APPROVED:
Inspector Date
_ 1