HomeMy WebLinkAboutDrain Layers Permit 60 Foster Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
/ BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereb grant( . to the Licensed Drain Layer
named herein to perform the..work 'ndicateci,be ow at �1 � ��
at premises owned by �� ;��/ j� � �
whose address is
Lay House Drain, Repair House brain, La Main and to
for y Other
Family Units, with acres occupancy or use, with
.
Type of Sewage to be connected under this permit:WASTES SANITARY SEWAGE( ), INDUSTRIAL
( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two.,j2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date v, / '" Estimated Time for Completion
Permit to be issued to --�— U
the holder of Drain Layer's License No. ! Permit will expire thirty,
after date of issuance. The undersigned Drain Layer hereby agrees to all e 'erms and
conditions set forth in the permit and the reverse side thereof. Ap�,1ic t s received
Town Permit No. and/or CHD Permit No. I'
Signed
Lice se Dra n Layer
The above named Drain Layer has a valid license issued (b the St�(e-o
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has filed a satisfactory bond and insurance policy in the name of the Town of�South Windsor:
Engineering Depar nt Date
Connection Charge_Paid_ _ �.�� -
permit--Fee: Paid $ -f �-
i Check Number
Issued by
Tax Office /.�......Cc9 .tea! i
INSPECTION
Date work started
11
Sufficient notification recei ed: dyes No
Special Conditions
APPROVED:
Inspector spate