HomeMy WebLinkAboutDrain Layers Permit 548 Foster Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
�\r�1 BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT d. 4 787
Pursuant to written application, f ' � I
Pp , permission is hereb graedj to te ..L}censed rain Layer
named herein to perform the work;:indicated below at / �, �adr�ess
at premises owned by �j, whosis
La House Drain and to
Y , 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 ( ), INDUSTRIAL
WASTES, ( ), OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
v
t
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 0 V?�. 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:
-Eng veering DcVartment Date
-------Connection Charge_ Paid "J---__I:'- `-� -
2 Per-met Fee:Paid--
�� �\ Check Number
1
'{ ( � UL--issued by
Tax office
INSPECTION
Date work started 705/ty leted
SUEficient notification received: Yes No
Special Conditions - Som�,(��Q O�/�M�ZtllGt
APPROVED: �7
Ins ector pate