HomeMy WebLinkAboutDrain Layers Permit 564 Graham Road 77
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT . 4645
Pursuant to written application, permission is here b granted to the Licensed Drain Layer
named herein to perform the work i icar�ed below at S
at premises owned by fL�f�,_, f0 v whose 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 �NDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish .two (2) copies of separate drawings.
t
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. P 4 . Permit will,/expire th rty (30) days
after date of issuance. The undersign Drain Layer hereby agre69 too 7j he terms and
conditions set forth in the permit and the reverse side thereof Epp ic4nt has received
Town Permit No. and/or CHD Permit No. „
Signed iTT �.
6' --Licensed Dra '-Layer
The above named Drain Layer has a valid license isst dd y the Sta_.e.-o€---C6nnecticut and
has filed a satisfactory bond and insurance policy in /zfame of Torwn-- South Windsor:
z9 a 7
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
.-Ce- l -A��,rn Issued by c.L 0'7 ._�.
-- -: -- Tax Office -
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
_- Sp-ecial_Cond.itions
APPROVED:
Inspector Date