HomeMy WebLinkAboutDrain Layers Permit 95 Foster Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTIQN CONTROL
DRAIN LAYER'S PERMIT 5
Pursuant to written application, permission is hereby granted the Licensed Drain Layer
named herein to perform- the wor Indic ted below.at gJ t :� >
at premises owned by jG c whose:.address is
Lay
and ,to
for House Drain; Repair I Buse Drain, T_ FLay
'Main
, ate,, other' ,
occupancy or use With
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ,^
WASTES , ( ) INDUSTRIAL
:Connection will be made :with
Show sketch of proposed work' 'or furnish two (2)- copies of separate drawings.
SPECIAL CONDITIONS A., a,
Desired Starting Date Estimated: Time for� Completion
Permit- to be issued -to -
the holder of Drain 'Layer's L c:ense'No: Peril will expire thirty' (30) rdays
after date of issuance. The undersigned Drain Layer hereby agrees to- all the-j' s and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No, and,/or CHD Permit No.
Signed „ ^
/CP 5r License&_Drain Lhyet
The above named;Drain Layer has; a valid ,license issued' by the,State` of Conne'c't'icut and
has filed a satisfactory. bond and insurance pglic�y: -in the naige of the Town of SoitH Windsor:
Engineering Department Date
:_- Gannet-ion-Char-Re-?&;id-41,40 -
.
Check Number
Tax Ofi. e
INS ECTION
-- - Date- work-started
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date