HomeMy WebLinkAboutDrain Layers Permit 620 Ellington Road TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 2 8 Ei;
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Pursuant to written application, permission is hereby ranted o he Licensed 'n Layer
named herein to perform the ork 'cate below t p�Q
at premises owned by - whose address is
and to
Lay House Drain, k. 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 (--Y, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS �ST
Desired Starting Date <!;5 - /-8 Estimated Time for Completion
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Permit to be issued to ,�, 2� /�✓
the holder of Drain Layer's Licen No. 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.
Signe
L' ensed Drain Layer
The 4bove 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:
Engin ng Depa Date
Connection Charge Paid Q� Permit Fee: Paid $ / 0:ely y
Check Numbpr �-9
Issued by
Tax Office
INSPECTION
Date k started Date completed ��-- U/- S
Sufficient notification received: Yes No '
Special Conditions Z2(- 4� `S --V
APPROVED:
Iii9pector Date
For
Date Time
WHILE YOU WERE OUT
M
From
Phone No.
Area Code Number Extension
TELEPHONED URGENT
PLEASE CALL WANTS TO SEE YOU
WILL CALL AGAIN I CAME TO SEE YOU
RETURNED YQUR CALL
Message
If
a
Cam+..,
Operator
INSPECTION REPO]
Date Time:
For: �� '`ry
(`Inspector.)/
Location: 'o2�
Day:
Type of of Inspection:
( 7C) Sanitary/Lateral
fZBS permit number
( ) Subdivision
( ) Site
( ) Other
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