HomeMy WebLinkAboutDrain Layers Permit 697 Griffin Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT t 4 N2 5852
- )(- t , 19 / Z
Pursuant to written application, permission is hereby granted to the
Licensed Drain �Ja e� amed herein to perform the work indicated below at
--�o�� gr +-ln t\ at -premises owned by
whose address is
:,�ai"�-e-- and to
Lay Hous Drain, Repair House Drain, Lay Main, Other
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 �+► � {
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS IQ d 051qA 1 ��� k0u-sr a( FUL(o4c)C-7_�>_
Desired Starting Date C F Estimat d Time for Compl tion
Permit to be issued to ro-,,, _._ _ r,v�
the holder 'of Drain Layer's Zicense No. 2U 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 permia .and the reverse side
thereof. Applicant has received Town Permit No. and%or
CHD Permit No.
Ca (lON) C� , � Signed
1 9- L oc)2 7 Licen e,d, Drain Layer
l
The above named Drain Layer has a val �.icense issued . by the State of
Connecticut and has filed a satisfactory . and and ::insurance policy in the
name of the Town of South Windsor:
_ E g nee i Deept Date
Permit Fee Paid $ '� 06 Check u bex. .
Connection Charge Receipt Tfio. Z3/` Dated
_ "-
INSPECTION
__DatP_�o_r1c—s_tax_ted.
Sufficient notif ica'�ion recei aa: No
- -Spe-ci-al --Conditions /of _
2� o
_. APPIt --- -_ _
Inspector Date