HomeMy WebLinkAboutDrain Layers Permit 589 John Fitch Boule TOWN 00 SOUTH WINDSOR
/;04 0✓ Gtiil�C�fl� DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ''<3 0171
IZZ, 19 .
Pursuant to written application, permission is hereby granted to 1'JeeJL3�en�ain Layer
named herein to perfor� th w ,-�
work indicated below at l�f
at premises owned by 9jt c�c +,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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder, of Drain Layer's License No. U goPermit 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 f South Windsor:
Engi Bering Deenyt Date
Connection Charge Paid �('71'7/ `� f Permit Fee: Paid $ 2,
Check Number 30, 3
Issued by
j' Tax Office
INSPECTION
. Date-work-started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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