HomeMy WebLinkAboutImported on 5/12/2009 at 8:19:17 PM _ i k
.v
TOWN, OF , SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OFF POLLUTION CONTROL
DRAIN `LAYER'S PERMIT. 4281
36
Pursuant to written application, permission is hereby grant _to the Licens d Drain Layer
named herein to perfo the or idicate�d below at .,
at premises owned by �� !e. �,i�_ �G(; �;� ,felt C whose address is
v 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.
�r
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to �ze
the holder of Drain Layer's License No. c 2 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. licant has received
Town Permit No. and/or CHD Permit No.
Signed
eensed Drain La
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 Depar ent Date
Connection Charge Paid-, S -- f U
� `� � Permit Fee: Paid $
tCheck Numbers t
ssued by
Tax Office
INSPECTION
-im e-work-started ___ Dane completed -
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date