HomeMy WebLinkAboutDrain Layers Permit 205 Foncine Lane TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT N , 4480
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the wo k indica ed below at
remises owned b
at � � � r^ ; ,c
p y Tyr K� i C1 whose address is
v` and to
Lay House Drain, 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. 4 17 Permit will expire thirty (30) days
after date of issuance. The undersignecr 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.
Signed fz
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:
ii
Engineering epart nt Date
Connee-tion_ _ ge Paid--/f,fij r ',-- ---Permit—Fee:-Paid- 3----- --
Check Number ''
Issued by
J Tax Office
INSPECTION
Date work_ star_ e t
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date