HomeMy WebLinkAboutDrain Layers Permit 455 Governors Highwa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS l�dY►'ti--, /I
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ®, 4128
�}55 C v urv►�rs �,
Pursuant to written application, permission is hereby granted to the Licensed,Drain Layer
named herein to perform the work indicated below at 'r'
at premises owned by ;l i r4- 's ;-� �'; _fit--�,�f whose" addre s 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 fux ish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of brain Layer's License No. zo 6-7.3 Z . 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 in thename of the Town of South Windsor:
Engineering Departm t Date
Connection C arge Paid Permit Fee: Paid
Check Number
Issued b -
Tax__af fiQe ---- - - -. - -
INSPECTION �- _T
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p ete
Sufficient notification received: Yes No /
Special Conditions pRpP -r44aI -ro gam; ►nJasn� --/ -¢13m`66_
APPROVED: A
Z� g�nspector r, pate