HomeMy WebLinkAboutDrain Layers Permit 570 Foster Street F . .
.� (TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
URgJAOF POLLUTION CONTROL
N LAYER'S PERMITv, 4849
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by -,,.y,�_ - ` x`
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 ( ), INDUSTRIAL
WASTES ( ), OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
f7_ `_'=
15,10
FE I 1�117VI�� /6�"F
SPECIAL CONDITIONS rose G
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. c2C>2 </a-7 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 114-1-1 J-e /_ ,,
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:
J Engineering Department Date
— -Connection Charge-Paid --
Ferm-it -Fee:-Paid
Check Number
o.
-, Issued by
Tax Office
INSPECTION
Date work started narp no plated
u dent notification received: Yes No
Special Conditions p„�, 77 5- S,e- �e
APPROVED: 12-2_15--07
InefFector Date