HomeMy WebLinkAboutDrain Layers Permit 383 Foster Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1rNJo. 4961
i
1A -CPt 19el
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work i di ted below at,
at premises owned by Q whose address is
La House Drain and to
Y , Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE A—, —INDUSTRIAL
INDUSTRIAL
WASTES ( ), OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
/-to
SPECIAL CONDITIONS
Desired Starting Date mcT• 2-/ , lye, Estimated Time for Completion
Permit to be issued to , 7),?'n—V
the holder of Drain Layer's License No. :2 p 8 2 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 :4censed
/Drain r
The above named Drain Layer has a valid license su by the State of Connecticut and
has filed a satisfactory bond and insurance policy t name of the Towp of South Windsor:
AT 2V
Engineering Department Date
-----Connection Charge Paid Permit Fee: Paid $ `�DU
Check Number &572
Issued by
Tax @ffice
INSPECTION
Date-work started Zd r 2- l / Date completed /Q
Sufficient notification received: Yes No
Special Conditions
APPROVE ll
Inspector Date