HomeMy WebLinkAboutDrain Layers Permit 107 Greenwood Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5400
I d 1 J t oGd Dr. .Ji9ryu,�2 Y 3 / , 19 949
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at X oT a2 Z-. GrPen/Uj00 r b 2 r V c—
at premises owned by -,_ j-G/UC n (5: !4 4"/o _ whose address is
E L-e'�r/iS Sir2PC-j rt/t'ti/i�IGTJ�J CT• and to
Lay House Drain, Repair House Drain, Lay Main, Other 5�-t/eo2.
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 ?.U, C •
Show sketch of proposed work or furnish two (2) copies of separate drawings.
oT 2 /i90uN r/V AJ ��a✓l e�_ �S r 7Ps
SPECIAL CONDITIONS
IONS QLL
Desired Starting Date z 0 Estimated Time for Completion
Permit to be issued to ZNC .
the holder of Drain Layer's License No. ZA g Z�/3. 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 ,
— Z censed Drain L
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:
Eng' Bering DepaffEent Date
Connection Charge Paid 4-t ` C -_-_Permit__Fee: P_aid_ $ -
1 Check Number Z¢/
- Issued by � Tom• �_`'�
Tax Office �
INSPECTION
Date work started Date completed _ _
Su icient 'notification received: Yes No
Special Conditions
oe
APPROVED
Inspector to