HomeMy WebLinkAboutDrain Layers Permit 296 Foster Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5124
19-10
Pursuant to written application, permission is hereby graaLed to he Licensed Drain Layer
named herein to perform the work indicated below at
at premise�owne�dby
^ whose address is
Lay House D , Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ),WASTES ( ), OR ( ) INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
N
t
SPECIAL CONDITIONS �^
Desired Starting Date E timated Time for Completion
Permit to be issued to
r
wl
the holder of Drain Layer's License No. Q
after date of issuance. The undersigned Drer hereby agreesPe it will xtorallhtheyterms 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 i he ame of the Town of South Windsor:
k-24 -88
Engineering Department Date
Connection Charge Paid Z
-- - -- zsa Permit Fee: Paid $ S (0 2-
Check Number
Issued by
Tax Gffice
INSPECTION
Date work started Date completed -
---- u icient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate