HomeMy WebLinkAboutDrain Layers Permit 30 High Street 2 e- TOWN OF SOUTH WI N DSOR
/ if�— DEPARTMENT OF PUBLIC WORKS
—�` BUREAU OF-POLLUTION CONTROL
DRAIN LAYER'S PERMIT o,, 5032
L-, i? I19L�
Pursuant to written application, permission is hereb grant to the icensed Drain Layer
named herein to perf2rl th work indicated below at-> 1 ;a, ,( _
at premises owned by ; 4 �(A : ") 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 connecteJ under this permit: SANITARY SEWAGE '(�-);INDUSTRIAL
WASTES ( ), OR Connection will be made with
Show sketch of proposed work or furnishtwo (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date '- z- ' -- n ;� stimated Time for Completionj-
7 /1
Permit to be issued to � / J �t;,.,x :,t_.,_,.4 1
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
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 f South Windsor:
EngitfeeringlSeppefient Date
Connection Charge Paid �`! {' X �- ��,j Permit Fee: Paid $ j Z"
Check Number /I ,
Issued by
/ Tax Office !
l
J
INSPECTION
ate work started-- ;�; -- c Date com feted >
Sufficient notification received: _ Yes No
Special Conditions
APPROVED:
Ea
rr
Inspector Date