HomeMy WebLinkAboutDrain Layers Permit 123 Greenwood Drive :IM17CM TWA—,
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kTOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 52U
Pursuant to writ n appI3 ation, permission is h r by_ ranted to the Licensed Drain L
named herein to perform t work indicated below at �� 7� / Layer
at premises owned by -- -N ,-G tZ
/V�,�.N&310-, C7— whose address is
House Drain and to
Lay , Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE �, 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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LT-a-I
Sew!✓t- /
SPECIAL CONDITIONS ---, �'`l %( O�t� C�•y� `
i
Desired Starting Me Estimated Time fpr Completion
Permit to be issued to r
the holder of Drain Layer's License No. 2-013 2 93 -.—Permit will expire thirty (30) da s
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
icensed Drain,5Zi6er
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 1cv _ j Permit Fee: Paid
f , Check_Number ? 21
Issued by
u�
` Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No K
Special Conditions -
APPROVED ,f
Inspector Date