HomeMy WebLinkAboutDrain Layers Permit 455 Foster Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3a
19 /
Pursuant to written application, permission is hereby,,, ant ;to th /Licensed Drain Layer
named herein to perform the wor/���nd}'cat:ed below at y , h at premises owned by W I l�7�-e�G Tti r u, S
-c'k V1 ,,,U whose address is
Lay
for HousepDrain, i '� Repair House Drain, La Main and to
!\R 5:c� y Other
Family Units, with occupancy or use, with
2 acres.
Type of Sewage to be connected under this permit: SANITARY S
WASTES OR EWAGE (�"), INDUSTRIAL
( ), ( )
Connection will be made with
Show sketch of progOse work or furnish two (2) copies of7pawings.
ci
I wz/aA P,11 1 �j
SP CI C DITIO�IS �-�IO U� 1,5 G!� �T l .�-,� ' � xe
--¢
Desired Starti Date U i Estimated Time for Completion
Permit to be issued _.._..._.-- �—
the holder of Drain Layer's License No.
�o�j•^ �. 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 irxjthe�name of t e Town of Sou h Windsor:
1 !
ngi eeri g partment Date
f ;
1
Connection Charge _-Pajdd`if','- -- ---- ----__ ---Fe uitf Fee:—Paid—
Che4 Nu�ber
Issued by
Tax Office 14
i
- INSPECTION
Date work started - Z_ - 9/ Date q I-
Sutficient notification received: es No
Special Conditions
APPROVED: S_ 2
Inspector Date