HomeMy WebLinkAboutDrain Layers Permit 130 Graham Road .. r .. _
TOWN OF SOUTH W1 N DSOR
\� DEPARTMENT OF PUBLIC WORKS
1 \\\ BUREAU OF POLLUTION CONTROL
� 4785
RAIN LAYER'S PERMIT 1�''A�77 N�,
/ r
Pursuant to written application, permission is h h x d Drain L�er
named herein to performsthe w 'rk indicated-rbelow at 130
at premises owned by L., - l �j C)L'` ( whose a 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 wor or rnish 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 Drain Layer's License No. p� . 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. 's 6 .
Signed,'•" a ��
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 'n the awe of the Town of South Windsor:
)Efigineeking Depaf ent fDate
Connection C arge Paid j Permit Fee: Paid $
r Check Number
/,
--- Tax Offi e_. _
INSPECTION
a e wor s ar ed TM--6-ompleted
Sufficient notification received: Yes No
Special Conditions ��v :j1 T � L,�I C16-
APPROVEP7b,L 7
Inspector Date