HomeMy WebLinkAboutDrain Layers Permit 44 Evans Crossing TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT4 9
44 W aAo VI oszL 1 C? 19
Pursuant to written application, permission is herPb�y ranted to the L'censed Drain Layer
named herein to perform thework indicated ,below..at J
at premises'owned by V 9{ �.--
whose,:ad ess is
r.
La House Drainand to
Y epair Mouse- Drain; zLa Main,' "
for -- — X Other ,
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 eeparate �drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for-,Completion
Permit_ to be issued-to'
the holder of Drain. Layer's Lidenise. NQ:. . 20,E Permit will ex ire. 'hirt 11L�� p Y (3a)'''days
after date of issuance. The undersigned brain 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
i .
.Signed..
Licensed Drain Layer
The above named Drain Layer has. a_valid license issued by''the State'`'of Connecticut and
has filed a satisfactory bona and ,insura}�ce policy ,in the name.-of; the Town of Eoutli'Windsor:
`Engineering De tmertt. _ Date
Connection Charge Paid c
Permit Fee: laid $ /�, Q D ..
Check Number 41(f J
Issued by
Tax Office
INSPECTION
Date work started date-cempletd---- ---
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date