HomeMy WebLinkAboutDrain Layers Permit 630 Governors Highwa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N0, 4716
'
19�f
Pursuant to written application, permission is hereby nted to the Licensed Drain Layer
named herein to perform the workindi to below at `- �`h
at premises owned by �;<'..,L t.� �CJCi' ( pad _6 whoo address(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 drawings.
A ` I
SPECIAL CONDITIONS
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) 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 receive
Town Permit No. and/or CHD Permit No.
Signed
Li a sed Drain Lay
f_)
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:
A-13 �2 V
Engineerfng Department Date
Connection Charge Paid - Permit Fee: Paid $
fs Check Number
1 -
- ,-Issued-by
Tax .Office
INSPECTION
Date work starte Date comp ete
Sufficient notification received: es No
Special_Conditions
APPROVED:
Inspector pate