HomeMy WebLinkAboutDrain Layers Permit 38 Jessica Drive T"riAfii7VAf`-.` 'YfE`4€+� 'a`r,�7•;41ca*-".� y+W-.�N??1�'t'r'Aa',+.: �'n.siF«'tiAF �,at,.z- ..W, .
TOWN, OF 2 SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OFF POLLUTION CONTROL
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DRAIN ` MER'S PERMIT l�T�. 428l
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Pursuant to written application, permission is ereby � rant _to the Licens d Drain Layer
named herein to perfo the worn, igidicated below at
at premises owned by _,k. rGL� ( f( C whose address is
w 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 o ze
the holder of Drain Layer's License No. c Z 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 lotcensed 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:
Z—L 7 *6
Engineering Depar ent Date
Connection Charge Paid/ Lb ,� � ,'`:j Permit Fee: Paid
Check Number
f
L14 r•�(l k-_: ;1 1 'J" � ,��,.,�ssued by
Tax Office
INSPECTION
-Datework-started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date