HomeMy WebLinkAboutDrain Layers Permit 177 Greenwood Drive T .
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT r '
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at e0 18 �rc,�� ,p,,,/ lsy�,,2►�L
at premises owned by
e ?U�S S �r'Gt/i�JG i t�it/ C 7-, whose address is
La House Drain and to
y Repair House Drain, Lay Main,
for Other ��;� ;•.7%�C
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE /
WASTES ( ), OR ( ) (`� INDUSTRIAL
Connection will be made with ' �' C
Show sketch of proposed work or/' furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date O Estimated Time for Completion / Y
Permit to be issued to _Dz_nw CO , .7AtJC
the holder of Drain Layer's License No. 2 08 2
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 recei
Town Permit Now and/or CHD Permit No.
•/ , 1 .
Signed . �.rrrr�
�1 jlcensed Drai 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 t
Permit Fee: Paid $
Check Number
Issued by
1 Tax f3ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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UOTICE
Vaprodt�cflons of this plan are invalid if they do
_ PERMIT PLAN fmUt burr tl;e impression seal of iha undersigned
Und Smmvor and/or Professional+ Engineer.
TATES
NC.
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