HomeMy WebLinkAboutDrain Layers Permit 577 John Fitch Boule :«fir v. v. ...
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4247
19 �.
Pursuant to written application, permission is hereby grant,.�d to�the ice�ed�grain Layer
named herein to perform the work indicated below at j 7 7 Q, ty
at premises owned by Z� whose address is
and to
Lay House Drain, u Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with. acres.
Type of Sewage to be connected under this p it: SANITARY SEWAGE ( , INDUSTRIAL
WASTES ( ), OR (') (•�it�„L,ac� Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
j� /
J
SPECIAL CONDITIONS -/ =�1 �` -J21
Desired Starting Date Estimated Time for Completion
Permit to be 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 all the terms and
conditions set forth in the permit and the- reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
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 Department Date
7/
Connection Charge Paid Z' ?�J Permit` Fee: Paid $
J Check u
Issued by -- �/
Tax Office /
INSPECTION
Date work started- --. - _ Date completed _ ------
Suff4,cient notification received: Yes No
Sp, Conditions
APPROVED:
Inspector pate .