HomeMy WebLinkAboutDrain Layers Permit 21 Jonathan Lane TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
ki{ pp
DRAIN LAYER'S PERMIT ���0 �8:8
�a
!d k 19 2a
Pursuant; to written application, permission is .hereby .granted to the
Licensed Drain Layer ame.& herein to 'perform the work indi ate4 below at
k,CJ I liYr� rlc+ ..: at premises owned by
whose address is A,4o dP� cr f and to
k Lay House Drain, Repair House Drain•, Lay Main, Other ,
for S(Vl � 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 , 7 VG
Show sketch of proposed work or Furnish two (2)" copies` of' separate drawings.`
.SP-EC'IAL-;COND-IT IONS
Desired Starting- .Date _ 1� -5-�z, Estimated Time for Completion
Permit to be issued to „ L(OA eCe, I�c:
the holder of Drain .Layer' s License No., 206 1(6 Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer .hereby agrees
to all the terms—and conditions set forth m the permit: .and the reverse slide
thereof. Applicant . has received 'Town Permi N .. andlor,
CHD Permit No. _
Signed 604
Licen Drain Layer
The above named Drain Layer has : a valid icense i sued .by the State of
Connecticut and has filed -a satisfactory ,bon : and insurance policy in the:'
name of the Town of South Windsor:
gineer ng Dept. Date
Permit Fee Paid' $ �f
Check Number
Connection Charge: Receipt No. Dated
Issued by
INSPECTION
Date, work started � — 1 - Date completed ¢—
Sufficient notificItion r ceivea, yes No
Spec Ll Con t ns
A A
-- - - - -- �APPR -- - �- .' -
nspector• Date