HomeMy WebLinkAboutDrain Layers Permit 658 Ellington Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ':: 5114
f 19a,
Pursuant to written application, permission is hereby g-Lted;,,tgotheed a' Layer
named herein to perform the work indicated below at
at premises owned by _ c. whose address is
and to
Lay House Drain, y-' Repair House Drain, Lay Main, A-= Other
for occupancy op use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: , SANITARY SEWAGE -(k_J_11"INDUSTRIAL -
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS r
Desired Starting Date Estimated Time for Comple'tibn
Permit to be issued to ` ( -0iV5S - Co- 2./ /c
the holder of Drain Layer's License 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 h7rece* ed
Town Permit No. and/or CHD Permit No.
Signed Gas
icensed Drain loor
The above named Drain Layer has a valid license issue by the State of Connecticut and
has filed a satisfactory bond and insurance policy in t name of the Town of South Windsor:
�,/
7w Engineering Department Date
/ 0_0
Connection Charge Paid /G40 Permit Fee: Paid $ �
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROV
Ins a or Date
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I hereby declare that this mop is substantially correct in accordance
with the standards of a Class D mop as defined in the "Recommended
;tandords for Surveys and Mops in the State of Connecticut" as prepared jog T"Wo ,
nd adopted by the Connecticut Association of Land Surveyors, Inc., on orrs•,. +
tember 13, 1984. This mop is compiled from other mops, deed ,�4'�v`AM'
ensions, and/or other sources of information and subject to change ��* `v }cm REINO E. HYYPPA B ASSOCIATES
field survey may disclose.
$ CIVIL ENGINEERS 8 LAND SURVEYORS