HomeMy WebLinkAboutDrain Layers Permit 1179 John Fitch Boul TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q_ lt�j►i
Pursuant to written application, permission is hereby granted to the licen ed Drain Layer
named herein to. perfom the wor.k, indic ted .be ow-:at
at premises owned by 0
whose address is
.Lay-Rouse Repair`House Drain, y �iid to
for Lay Main, :. Other-
Faiaily Units, with occupancy or use with`
acres.
Type of Sewage to be connected under this permit: SANITARY
WASTES SEWAGE O, INDUSTRIAL
O, OR O. Connection will beimade with
Show sketch of proposed work' Or furnish two'(2) copies of separate drawing's.
SPECIAL CONDITIONS
Desired Starting Date - Estimated Time for-Completion
Permit_ to be issuef to' a
the holder of Drain Layer!i'-License No.
Permit will expire thirty ..( days
after date of issuance. . The" undersigned Dra"In Layer hereby, agrees to all the'te ms. and
conditions set forth in the permit and the reverse side thereof. •Applicant has received
Town Permit No.. and/or CHD Permit No.
Signed -
Licensid Dxalh Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance,polic in th yne of the' ' of'South Windsor:
L. -t�5
6/0 00- 0 0 !Engineering Depa ent -hate
Connection Charge Paid L-1 44 -�*4 tt,�I permit Fee:' Paid $ 0
Check Number y
�J Issued by
Tax Office
INSPECTION
---—Date-work-started _ ---_ . ____ _--- -- __. ---- ---- _ -- ----- ---- - -
Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date