HomeMy WebLinkAboutDrain Layers Permit 40 Jessica Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4994
40) a
1 C!� UA , 19V
6
Pursuant to written appAc permission is he eby granted to Licgpsed Drain Layer
� y
named herein to perforwthe work in is ed .be ow at y .
at premises owned by V
Q ` 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 furnidh two (2) copies of separate drawings.
_ 1
SPECIAL CONDITIONS
Desired Starting Date -,? Estimated Time .for.Completion ;
Permit, to 6e issued `to`
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 alb:` the t0.i*i.and
conditions set forth in the permit and the reverse side thereof. ' Applicant has received
Town Permit No.. and/or CHID Permit No.. ,
Signed
Litensed Drain Layer.
The above named brain Layer liar, a valid license iss�ied by the State of 'Connecticut and
has filed a satisfactory bond an insurance policy; in the nerve Qf 'the Town of:" oiiti `Windsor:
yz
Engineering Department. Date
Connection Charge Paid Permit Feet Paid $
Check Number
9
' Issued by
Tax Office
INSPECTION
Date workstarted Date completed
Sufficient notification received: Yes No
Special Conditions -
APPROVED:
Inspector Date