HomeMy WebLinkAboutDrain Layers Permit 66 Jessica Drive ... , 'i^'�-+'�F tr,,�'ic9.++'i�Fr. _ ._ _��....„..,,..,.,?s:-7r .s,� _•::F.r. .w°P5-'�"=`K�u.. g..,s.c-..F,a•-ay.nq.�.,.;_, _
TOWN OF ` SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL A�
DRAIN LAYF 'S PERMIT X90. 41-9 4
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Pursuant to written application, permission is ereby ranted to the Licensed Drain Layer
named herein to perfOr44 the work ndicate,below t f.
at premises owned by 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 furnish two (2) copies of separate drawings.
P $
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.z! _. Permit will expire thirty (30) days
after date of issuance. The undersigned Drayer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has rec 'ved
Town Permit No. and/or CHD Permit No.
Signed
L erased 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:
En i eering Department Date
Connection Charge Paid, g� r f �`
U �l � t�c,;�. Permit Fee: Paid $
fA, Check Number
' -cl- ? / - r 7 Issued by
Tax of ice
INSPECTION
- -Da �wark startad__ _ __.-_ ____. -Date cbmpleted-
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date