HomeMy WebLinkAboutDrain Layers Permit 47 Jonathan Lane ;.. �.
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at 3 i �1 �� r,; L.�1 -4 -7
at premises owned by ( ,i 4 c Cch.<, whose address is
?�iu,.,( 1-P% IP, C, no) and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for ,,;. N �, Pill , j occupancy or use, with
Family Units, with acre .
Type of Sewage to be connected under this permit: SANITARY SEWAGE (v'j, INDUSTRIAL
_WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date j 77 Estimated Time for Completion 1
Permit to be issued to ), I Li w�, e✓ <f c L
k, ( yti� i
the holder of Drain Layer's License No. � 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 J
Li sed Drain Layer
(
The above named Drain Layer has a valid license isgUe� by the State of Connecticut and
has filed a satisfactory bond and insurance policy io tli ,name off Town of South Windsor:
ng neer%n ,. epartment Date
Connection Charge Paid U ���9/ Permit Fee: Paid $ z i
Checkf�Number 41
Issued by �.
Tax Office i
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INSPECTION
Date work started -�f Date completed
Sufficient notification received: es No
Special Conditions
APPROVED: r
Inspector pate