HomeMy WebLinkAboutDrain Layers Permit 120 Foster Street TOWN OF SOUTH WI N DSOR
�H DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
L DRAIN LAYER'S PERMIT 'o). 5047
3 /,/ 19 � �
Pursuant to written application, permission is hereby ed to t e Licensed Drain Layer
named herein to perform the yQrk indicated below at _�Zl1
at premises owned by whose address is
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 X' INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
a
SPECIAL CONDITIONS
:Desired Starting Date Estimated Time for Completion
Permit to be issued to (
the holder of Drain Layer's License No. I 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 "77;/
Licensed Drain La
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:
_•ter r- �'/.� � J P
Engi eering DepArt&ent Date
Connection ge Paid 7C Z 3 / C! Permit Fee: Paid $
Check Number- 3 '-
A I
Issued by ��_
-Tax-Af-f-ice-- - - -- - -- _ --- -- --- -__—--- _�.-_----- -- �_ - ------
INSPECTION
Date work started — OW .-Date completed P
Sufficient notification received: A-- Yes No
_ Special Conditions
APPROVED•
Inspector Date