HomeMy WebLinkAboutDrain Layers Permit 400 Foster Road o TOWN OF SOUTH WINDSOR
\�S DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ND 5352
19
,17
Pursuant to written application, permission is here y gran d to t�Licensed Drain Layer
named herein to perform the work indicated below at 0 /OS A& 2
at premises owned by (:, /r M eo r _ whose address is
�� 0 go s c N
to
Lay House Drain, �1 h' Repair House Drain, Lay Main, and Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE (A, INDUSTRIAL
WASTES ( ), OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 0— r ) " /Estimated Time for Completion O
Permit to be issued to
the holder of Drain Layer's License No. ermit will expire thirty (30) days
after date of issuance. The undersigned Drain Lay e ereby 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
.y
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 polic in he name the Town of South Windsor:
E gine Department Date
Connection Charge Paid -JAN- ?jF, r t Fee: Paid $ 15 ,00
eck umber
Issued by
Tax Office
INSPECTION
Date work started Date completed
- -Sufficient notification received: 6---Yes No
Special Conditions
APPROVED:
I pector pate