HomeMy WebLinkAboutDrain Layers Permit 184 Foster Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT jo, 4390
v/ 19 u
Pursuant to written application, permission is he y gr ted to th Licensed Drain Layer
-named herein to. perfor - the work in4,icated below at
at premises owned by
�--5 �+- whose- address is
Lay House Drain, , ay an, and to
Repair House Drain L Main, Other
for ,
occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: S ITARY SEWAGE ( NDUSTRIAL
WASTES ( ), OR Connection will be made with
Show sketch of proposed work or furnish two (2) copies of Giq sep rate drawings.
11�0 ��N
�� ��
o�.'�— /�
G4 �
SPECIAL CONDITIONS 0 ,
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) da s
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 d by the State of Connecticut and
has filed a satisfactory bond and insurance poli n e name of the To of
South Windsor:
�5 Engineering Departm nt ate
—CorMection Charge- Paid.. -Fee- Paid
r
1 Check Number �---
� Q__yssued—by_ — - - -— -- - - --
Tax Office
INSPECTION
,-------Date -work started
u icient notification received. Yes No
Special Conditions
APPROVED:
Inspector Date