HomeMy WebLinkAboutDrain Layers Permit 25 Evans Crossing TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT140-M12-
015 Marto ( 1A 19 dl `r
Pursuant to written app ication, permission is hereby to t ranted
named herein to. perform the work indicated below at $ h� Licensed Drain Layer
at premises owned by
whos address is
Lay House Drain, Repair House Drain ;and to.i
for Lay Main, s. Other
Family Units, with occupancy or use, with
acres.
Type of Sewage to"be connected under this permit: SAN
WASTES OR ITARY SEWAGE ( ), INDUSTRIAL
( )� ( )
Connection will: be made with
Show sketch of proposed work or furnish two (2") copies of separate drawin" s.
. _.,
SPECIAL CONDITIONS
Desired Startifi'g Date Estimated Time for .Completion
Permit_ to ',be issued to
the holder of Braid `Layer's License No.' a 6 Zed Permit will expire thirty (30)' days
after date of issuance. The undersigned Drain L y r Hereby
conditions set forth in the permit and t agrees to all, he terms and
he. reverse side thereof. Applicant has received Town Permit No. . and/or.'.CHD Hermit No.
Signed
Licensed, Brain-
Layer l
The above named Drain Layer ha$. a..val,id license issued by the "State`of Connecticut and
hasCfiled a satisfactory bond and insurance policy in tl�e name.„Qf the 'town of. Soutf 'Windsor:
oho o
u ,Z 7- 3�13
Ainee ing Dep rt nt. ,k, Date
Connection Charge Paid QQ d Permit'Fee:' Paid $
Check Number
�. j\ G Issued by
Tax Office
INSPECTION
Date work started Dat;O-Gomp-leted
6utf1cient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date