HomeMy WebLinkAboutDrain Layers Permit 133 Greenwood Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is her by ranted to the Licensed Drain Layer
named herein to perform thework indicated below at :t 7�
f L�G'ryu�7 r+
at premises owned by �� nL-t Z--;yam whose address is
7 LC�Gi/i 5 ST `v� /,N��oN �T_ 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 (PI, 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 Estimated Time for Completion
Permit to be issued to zr/,j Cc2njS1 • C-p, "'jc
the holder of Drain Layer's License No.2D S Zj j 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 DtogYn 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 of South Windsor:
Engineering Department Date
Connection Charge Paid i - l' Permit Fee: Paid � 5 7
Check Number i
dux'-- Issued by
Tax Office
INSPECTION i
Date work started -Date completed
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Special Conditions
APPROVED:
Inspector Date