HomeMy WebLinkAboutDrain Layers Permit 33 Grace Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
RAC- DRAIN LAYER'S PERMIT .';�a 5483
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform t,4e work indicated below a k2,a
at premises owned by whose address is
::5'flAZ6 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 K), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date �S - 6- Estimated Time for Completion '' s
Permit to be issued to J $ fk `j 4fnl— C-C.'asc cz'. h3c .
the holder of Drain Layer's License No. ZO"7-7 Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Laye a by agrees to all the terms and
conditions set forth in the permit and the reverse ide of.
Applicant has recce—
Town Permit No. and/or CHD Permit No.
Signed ? /a/ ��
Licensed train Layer
The above named Drain. Layer has a valid licenae issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 1 Permit Fee: Paid $
L Check Number
Issued by - -
- - --- Tax Office
INSPECTION
Mfg- wor started§tdrted Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: e
Inspector Date