HomeMy WebLinkAboutDrain Layers Permit 25 Hearthstone Drive TOWN OF SOUTH WINDSOR 2
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1vN�. 4493
19
Pursuant to written application, permission is here y grafted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by /(' f—{ ��_f ,�� ���� 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
the holder of Drain Layer's License N L O '22 G Pe mit will expire thirty (30) days
after date of issuance. The undersig ed Drain Layer h eby agrees to all the terms and
conditions set forth in the permit an the revers de thereof. Applicant has received
Town Permit No. and/or CHD Perm' i 'FT0.
Signed L /� ,
c, 2-
Licensed Drain Layer
i,
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:
Eng neering Department Dote
Connectiou,Charge Paid Z (-"Z~ / -� Permit Fee: Paid $ Z �!
J / i
Check Nur .er)
?
Issued by
Tax affice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date