HomeMy WebLinkAboutDrain Layers Permit 769 John Fitch Boule TOWN ' OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a, 4362
Pursuant to written application, permission is ere y ted to,the Lice!, d D ain Layer
named herein to perfo th work in icate below at � ; �'
at premises owned by , _ j whose address is
If')/V- Cat1 RrT-E-A .S-0. , . '- Ny ./U /Z -5— and to
Lay House Drain, Repair House Drain, Lay Main, Other ' ,
for 6 s TWORW-A_,r— 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
'1 L -- �5-I)R 3S
Show sketch of proposed] work or furnish two (2) copies of separate drawings.
v'
y
i
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for.Completion
F(.=�wK KAPst fl
Permit to be issued to I-,
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer eby agrees to all the terms and
conditions set forth in the permit and the reverse side reof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed 2,0(oci`q
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 poll c in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid' � .0 t)S Permit Fee: Paid $ j 0 Q
Check Number
r
i� Issued by
j Tax Office
INSPECTION
- Date work- started_ - - -- Date- completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date =: