HomeMy WebLinkAboutDrain Layers Permit 584 Governors Highwa S r-. -...v - ,;.XT �-`ljlr+5 .rts., r an
TOWN OF SOUTH WI N DSOR
I� d-. DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL AATT
DRAIN LAYER'S PERMIT j'�No, 4720
19�
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the Work indicated below at t
at premises owned by whose dress is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawi s.
/7Z�-P �za
SPECIAL ONDITIONS
Desired Starting #DatW 6 Estimated T' a for Completion
Permit to be issued to /tL �ih x,C<nan,,� Co„
the holder of Drain Layer's License No. 6 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 r eived
Town Permit No. and/or CHD Permit No. ` )� ,
Signed` `
c nsed Drain .ay�r
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ii the me of the Town of South Windsor:
E gineering DepAktment Date
Connection C rgf- Paid 716 ? Permit Fee: Paid $ C� 7
�- Check Number S� '
- --E - - -- - - - - --- --- - --- - ---- - Issued-by -- - -
Tax Office
INSPECTION
Date worR s ar a ate comp ete
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date