HomeMy WebLinkAboutDrain Layers Permit 3 Karen Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT to. 4682
19 j
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to performthe wo indicated below aty„�
at premises owned b >t� '2
y f.r whose address is
La House Drain and to
Y , Repair House Drain, Lay Main, Other
for ,
w
Family Units, with acres. occupancy or use, ith
Type of Sewage to be connected under th' e i : SANITARY
WASTES ' 4z 1 USTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 3 - 2 U Estimated Time for Completion
Permit to be issued to j✓ /JZ CO w5 77. �'c>
the holder of Drain Layer's License No. 20(r2 Z G . 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
Licensed 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 n e name of the To of South Windsor:
000,
0 7
Engineering Department Date
Connection Charge Paid ����� . }( Permit Fee: Paid
l (( Check Number
-C l C{ ` r,l Issued by
Tax Office
INSPECTION
Date work started Date completed
--------Suff-ic ent notification received: Yes No
Special Conditions
— -- APPROVED: -
Inspector pate
Construction Inspection Report
Project
. Streef Time
rx�` -e GEC dam/®
Weather Insp.�
Developer Contract
Work in Progress
Problem Areas ,
Special Instructions/Orders / /