HomeMy WebLinkAboutDrain Layers Permit Ellington Road - Tow A TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
ail BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT . ' .
19 —
Pursuant to written application, permission is h reby granted to__the Licensed Drain Layer ,
named herein to perform the work indicated below at` %Ll,
at premises owned by >k- 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 ( INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 7_ 01 Estimated Time for Completion 2 r /Jfl
Permit to be issued to •� ^t �d_r_ I Z't c,t.. I J c _0
the holder of Drain Layer's License No. l Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer- he\eby agrees to all the terms and
conditions set forth in the permit and the reverse ,'side1thereof. Applicant h�s received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid licen e• issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name a€ the Town of South Windsor:
Engineering Department 'ate
a Paid
g Permit Fee: Paid
Connection Char
Check Number
GL. t� A'�1� Issued by
Tax Office
INSPECTION
Date vork started �"'9 Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Ins cto pate