HomeMy WebLinkAboutDrain Layers Permit - repair 30 Foster S TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT R.," 5 6 8 D
- i'1 iti Vd
19
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at r S i I-
at premises owned by yry �- r ,-� ��7 � f whose address is
Lay House Drain, Repair tees a Drain, La Main and to
for 1 t F; Y Other ,
Family Units, with acres occupancy or use, with
.
Type of Sewage to be connected under this permit: SANITARY SEWAGE WASTES ( INDUSTRIAL
( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
114
n ,n
SPECIAL CONDITIONS
Desired Starting Date ;✓ G �- Estimated Time for Completion 4
Permit to be issued to
the holder of Drain Layer's License No. G r t� 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.
Signed
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:
Engineering Department Date
Connection Charge Paid -Permit--Fee.--Paid--$ - - -
Check Number
Tax Office Issued by
INSPECTION
Date work started Da-t-e-eompretezl
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date