HomeMy WebLinkAboutDrain Layers Permit 70 Judge Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITb
:v 56 1
Pursuant to writt application, permission is hereby granted to the
named herein to perform the work indicated below at Licensed Drain Layer
at premises owned by `;y ,�} IS u p 6 t1 aIC
whose address is
. )X,I- n Repair House Drain, L Main and to
5 ay for , ��6C� F�l M Icy Other .
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this WASTES ( ), OR ( ) SEWAGE kQ, `INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Z $ e / Estimated Time for Completion L !
Permit to be issued to �cT7�'1 cJ fIL JCL%
the holder of Drain Layer's License No. o '7 �,2 S perm w 11 S ire thi t C SEEj` /cE"
after date of issuance. The undersigned Drain Layer hereby agrees' to all the yterms ands
conditions set forth in the permit and the reverse side thereof. Applic nt ,has rec ived
Town Permit No. and/or CHD Permit No.
Signed Q'"L41L,
Lic used Drain Layer
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 the name of the Town of South Windsor:
Engineering Department / Date
Connection Charge Paid /i�(�(/ 1. J
� Permit Fee: Paid $ 7_--�5
Check Number 41
Issued by.
Tax Uffice
INSPECTION
Date work started / Date completed
'Sufficient-notification received: _Z� yes No
Special Conditions
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APPROVED: S r
nspector D to