HomeMy WebLinkAboutDrain Layers Permit 450 Foster Road TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL C A
DRAIN LAYER'S PERMIT ' " O 5901
/ 9 F3 19
Pursuant to written application, permission is hereby granted to the
Licensed Dra-in .Layer named herein to perform the work indicated below at
a t ,p r e m i s e s owned by Rom_
whose address is RZ Soul rI. u/��✓� o� 11 and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for j,'L-5113/ /VCR occupancy or use, with On/�6
Family Units, with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( s,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with 6/C'_
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS �'j'OG�-�/1/� Cj(/l3 f� 4t2f
Desired Starting Date /0/9�a Estimated Time for Completion 49&/74/rS
Permit to be issued to 44TuLif-Y-£' lr.� r/-I&otfS /4�.
the holder of Drain Layer's License No. 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. 9Zo2079 ,
,.. Signed
Licensed Drain yer
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:
En 'ne ring Dept. Date
Permit Fee Paid $ .Q� Check Nu er
Connection Charge Receipt . No. r3- Dated' 2 -jj-C? j
INSPECTION
=D-at-e•--tiro-r k---start-e d �JrJ --- _--
---,-Date completedSufficient notification receive3.- Ti'` yes No
Special
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��� •Inspector Date
1.