HomeMy WebLinkAboutDrain Layers Permit 25 Haystack Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT jo. 4664
19 b -2
a 14& sfa C
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at /
at premises owned by L/ 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 ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to `✓�u�1v� i_1 01
the holder of Drain Layer's License No. 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 received
Town Permit No. and/or CHD Permit No.
Signed
Lice sed Drain Layer
The above named Drain Layer has a valid license sued by the tate of Connecticut and
has filed a satisfactory bond and insurance policy. in tjhe name of the Town of South Windsor:
h/7 �
Eng neering Depart e t Date
Connection Charge Paid lZ ' LlA/6' 2 Permit Fee: Paid $ S 71
.� Check Numbeg_,
c
Issued by '' MI-1,,,
Tax Office
INSPECTION
_ D-ae work- started Ij Date completed
Sufficient notification rec ived: es No �-
Special Conditions
APPROVED: 6 /
Inspector Da e