HomeMy WebLinkAboutDrain Layers Permit 202 Foncine Lane ,� _ .�.. �.. ...-o 'ri✓ .... -r✓•_"o�!".T^:I'l4: ." -.[r•1'r5:�.11wl�Tl
TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO, 4477
,Vl , 14
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the cork indicated below at �� �uLj n A
at premises owned by_1_FV-/i_ awn whose address is
La House Drain and to
Y 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 ( ), 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 issued to
the holder of Drain Layer's License No. ,10) Permit will expire thirty (30) days
after date of issuance. The undersigned Drain ayer 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.
r
Signed ' tr
Licensed Drain Layer
The above 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:
cG
Engineering epartment Date
-- Conne -Char Paid_ = - _
- = - —Per Fee.—Pa#d-- - -- -
Check Number
Issued by
Tax Office
INSPECTION
_ Date wo
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date