HomeMy WebLinkAboutDrain Layers Permit 56 Hazel Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NQ 5188
l 19�' d
Pursuant to written application, permission is here nted t e icensed Drain Layer
named herein to perform the work indiSabed bekow t
at premises owned by 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 thi perm t._ SANITARY SEWAGE -( INDUSTRIAL
WASTES ( ) , OR ( ) �� �j.j /%F�� Connection will be made with
Show sketch of proposed work or�fu ni�sh two (2) copies of separate drawings.
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SPECIAL CONDITIONS L
Desired Starting Date Estimated Time or Completion
Permit to be issued to �Gtrv� ✓�iY�,t,(%,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/—rl �;,.L. LZJ r1J�a� ,C2 _
` Licensed Drain 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 C 4WF Permit Fee: Paid $
Check Numb 7(q y y
Issued by i .
Tax fice
INSPECTION _
Date work started ) Date completed
Sufficient notification receiv d: Yes No
Special Conditions
APPROVED•
Inspector pat