HomeMy WebLinkAboutDrain Layers Permit 96 Greenwood Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT
.292
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Pursuant to written application,PP , permission is her anted� to�,the Licensed ,Dr n Layer
named herein to perform the rk indicated_ below at
at premises owned by /J/ �e5
whose address is
and to
Lay House Drain, Repair House Drain,
for Lay Main. Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE(Vf, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separa e d S.
817 z..3 D 18 zIL
ere
VAJ
SPECIAL CONDITIONS
Desired Starting Date tf N q Estimated Time for Completion srV6_ K
Permit to be issued to n/9 7- CCU 1 A)
the holder of Drain Layer's License No.2 Permit will expire thirt after date of issuance. The undersigned DrainLayer hereby agrees to all the termsands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain er
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 411V
'r/�E,�� 1 -- - Permit-Fge:-Paid -- -- -
Check Nu3 7 / o
t Issued by
Tax Office
INSPECTION
Date work started completed--
-Sufficient notifica ion received: — Date
Yes No
Special Conditions
APPROVED:
Inspector �Aie