HomeMy WebLinkAboutDrain Layers Permit 275 Griffin Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT "120 5191
Pursuant to written application, permission is hereby gran ed to the icen ed Drain Layer
named herein to perform th work indicated below at
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at premises owned by (� � ------ � I fJ�x
whose- address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ,
WASTES ( ), OR ( ) Sf'7 INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
ED
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a p
SPECIAL CONDITIONS f Y
Desired Starting Date Estimated Time for Completion
Permit to be issued to —2K-(4 1 z�
the holder of Drain Layer's L cense No.
Permit will after date of issuance. The undersigned Drain Layer hereby agrees xtor all htheyterms ands
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 Layer
The above named Drain Layer has a valid license issued b the State of Connecticut and
has filed a satisfactory bond and insurance policy in t n e of the Town of South Windsor:
Engineering Department Z r
Da
Connection Charge Paid A10 a
- -- -_Permit--Fe-eT-Paid-
Check Number
Issued by ff
Tax Office
INSPECTION
Date work started _ -9
Suf��-ien-t-notification received: Date completed- ----
- Yes No =
Special Conditions
APPROVED: ---' A-1 2 : J
Irt9pector
Date