HomeMy WebLinkAboutDrain Layers Permit 1596 John Fitch Boul TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5067
19
Pursuant to written application, permission is hereby gra ,ted,,,to the—Licensed Dra* Lay
er
named herein to perform the Vork ind' t d-,b1ow at
at premises owned by Z-24 2-z- --y whose address is
U and to
Lay House Drain, Repair House Drain, Lay Main, Other V
for C ,a C &tAApe �, ,- -C occupancy or use, ;with
Family Units, with <3 acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O�), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
61, Pan
Show sketch of proposed work or furnish two (2) copies of separate drawings.
)VA
t> la
SPECIAL CONDITIONS V
Desired Starting Date Estimated Time for Completion
Permit to be issued to S4
the holder of Drain Layer's License No. Qo7(oO 6-A 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
Liden,s,,dd air in Lay r,
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 �hd' me of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
A'.�!
Check Number
Issued by
Tax Office
J—
INSPECTION
Date work started --Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
7-77 -7 77
Inspector Date