HomeMy WebLinkAboutDrain Layers Permit 1790 Ellington Road TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC-WORKS
BUREAU BUREAU OF POLLUTION CONTROL
52
r gv�DRAIN LAYER'S PERMIT z°=,� Q�.�
Pursuant to written application, permission is hereby granted to .the 41 ensed Drain Layer
named herein to perform the work indicated below at:
at premises owned byr/Q' -�' whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for ,_,e. occupancy or use, with
Family Units, with acres. --
Type of Sewage to be connected under this permit: - `-SAN_ITARY 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 Estimated Time for Completion
Permit to be Assued to l✓rLL/ -,
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 has received
Town Permit No. and/or CHD Permit No.
/c•y�/�f/,..� `�� Signed --* "
;,6 111-6 e? �"�, ` ice d Drain Layer
The above named Drain Layer has a valid license is ed by the State of Connecticut and
has filed a satisfactory bond and insurance policyt i name of the Town of South Windsor:
Engineering Department .. Date
Connection Charge Paid Permit Fee: Paid $
73 -Check 'Number'
�,- Issued 'by
Tax Office
INSPECTION
Date-work—started-
------
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date