HomeMy WebLinkAboutDrain Layers Permit 417 John Fitch Boule TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 2®b
�' c 19 ,
Pursuant to written application, permission is hereby sn:
d t_o__t�e ,,ice sad Derain Layer
named herein to perform the work, indicated below at , V' 4�
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 O, INDUSTRIAL
WASTE (�),�Al ) Connection will be made with
6 � �
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
i
Desired Starting Date Estimated Time for Completion 15,
Permit to be issued to �'/fir � �Dy ,
the holder of Drain Layer's License No. 2 6 6C. 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 t1ier-eoy 'Applicant has received
Town Permit No. and/or CHD Permit No.
6�.
Signed -:'y'._ t
Licensed Drain Laye
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 t Date
Connection Charge Paid / s (" W /j Permit Fee: Paid $ 1
Check Number --
�''l r
Issued by
Tax Office /
INSPECTION
Date-work started - -- Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
N
s
i
I n
MOTES SOUTH WINDSOR POLLUTION COWRO
LOCATION l 7
OWNER
TYPE OF WORK
-S ,7t PE IT -. - ,3'PIPE
INSTAL FR Zv
INSPECTOR S: C--- DPATIN--BT-- --