HomeMy WebLinkAboutDrain Layers Permit 30 Jonathan Lane o TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
a BUREAU OF POLLUTION CONTROL
• ���� DRAIN LAYER'S PERMIT 1"4
o 5847
/0 - 7 19 9Z
Pursuant to written application, permission is hereby granted to the
Licensed Dr in Layer named herein to . perform the work indicated below at
tt vl1a �u at premises owned by
whose address is �_ vas and to
Lay House DLain, Repair House Drain, Lay Main, Other ,
for ( IC occupancy or use, with
Family Units , wit acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR .( )
Connection will be made with PI/C
Show sketch of proposed work or. furnish two (2) copies of separate drawings.
- SPEC-IAL CONDITIONS _
Desired Starting Date Estimated Time for Completion
Permit to be issued to A L 1vL..-
the holder of Drain Layer' s License No.o� y ermit will expire thirty
(30) days after date of issuance. Theaundersigned Dyrain 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
icens Drain Layer
The above named Drain Lager has a valid l cense issued by the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town of South Windsor:
En �er
e ring Dept Date
Permit Fee Paid $ Check Nu
Connection Charge Receipt No. Dated aC
Issued by
INSPECTION 177
Date work started Date completed
Sufficient notification �,ece ve : es No
Special ConditionsIL
APP
Inspector Date