HomeMy WebLinkAboutDrain Layers Permit 7 Haystack Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO, 4790
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at j �`�,_fA. ` .,� t__.
at premises owned by jj� 1 _ whose address is
and to
Lay House 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 ( t<INDUSTRIAL
WASTES ( ), OR ( ) �p �� �(�C Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time .for Completion
Permit to be issued to
the holde of Drain Layer's License No. ��rE„�a� Permit will expire thirty (30) days
after dat 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.
t Signed IL a �4,
{ j Lice sed Drain Layer
tY i
The above named Drain Layer has a valid license i spied by the tate of Connecticut and
has filed a satisfactory bond and insurance policy, in t�h'e name o e Town of South Windsor:
Engineering Department / Date
Connection Charge Paid X60 •U 0, Permit Fee: Paid $
Check Number
i
s2 it%� (--( !', i Issued by
Tax Office
INSPECTION y
ate ork started - g T Date completed
Sufficient notification received: Yes No
Special Conditions
APPROV '
Inspector pate