HomeMy WebLinkAboutDrain Layers Permit 53 Jessica Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT V04258
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at L J- '4 4) le h r; u-c_
at premises owned by i I 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 SEWACE INDUSTRIAL
WASTES OR Connection will be made with
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Show sketch of proposed work or furnish two (2) conles of separate drawings.
7- Ll C2
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to �) Q-t-11, - a I
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 thereo);fr. p icant ha eceived
Town Permit No. and/or CHD Permit No.
Signed
/ 4� nsed Dr Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policyin the name of the Town of South Windsor:
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Engineering Department Date
Connection Charge Paid 4,a)j I I Permit Fee: Paid $ o o
Check Number
Issued by
Tax Ottice
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INSPECTION
Date work smarted-- --Date
completed_ -
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date