HomeMy WebLinkAboutDrain Layers Permit 2 Jeffrey Drive 7y.*;�
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TOWN OF SOUTH WINDSOR
1:
DEPARTMENT OF PUBLIC WORKS 00
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT MO. 4294-1
-t- -7 1./1 ,
Pursuant to written application, permission is hereb �_Wted to the Li /used Drain Layer
named herein to perform th,� wo k indicated below at
at premises owned by Jwhose 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 No. Zb,,&3 Y6-. 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
Sign
" d--t,
17 1 1 1 Licensed brn Layer
The above named Drain Layer has a valid lic�nse//issued by the State nnecticut and
has filed a satisfactory bond and insurance policye name of the Town of South Windsor:
*n th
-17 7- 227
Engineering Depar-ttlent Date
Connection C4 .& Paid 5�_Ah_b ' Permit Fee: Paid $
I 't 2-Xk
Check Nu leer. 133 z
z (?_ qb
Issued by
Tax Office
INSPECTION
Date work -at-arted Date completed---
notification received: Yes No
Special Conditions
APPROVED:
Inspector Date