HomeMy WebLinkAboutDrain Layers Permit 254 Graham Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereb
named herein to perform the work indicated below at �, Y grant;ed�x
to he Licensed Drain Layer
,� / -� -
at premises owned by
whose address is
Lay House Drain, ✓ Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
WASTES OR Type of Sewage to be connected under t 's permit: SANITARY SEWAGE "( V INDUSTRIAL
( ), ( )
— 442 Connection will be made with
Show s"te ose k o-, furnish two (2) copies of separate drawings.
C k)E"C. C:ii!v F {�
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VC
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SPECIAL CONDITIONS T
Desired Starting Date Estimated Time for Completion
Permit to be issued to
kl r
(� Sf u, `t�1NK � U ,CE
the holder of Drain Layer's License No a LVN�L U
after date of issuance. The undersigned D—rai— 'n Layer hereby agreesxtorallh they
terms ands
conditions set forth in the permit and the reverse side the eof. Applicant has received
Town Permit No. and/or CHD Permit No.
1/
Signed
ed 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 the name of the Town o South Windsor:
Engineering Depa ..t Date
Connection Charge Paid
Permit-_Fee:_ Paid
Check Number
14 Issued b
Tax Office Y
INSPECTION
Date work started _
Sufficient no-t-if ic-a-ton--reeeiv �3;-- -— Date complete
Special Conditions es No
APPROVED• . _
Inspector pate