HomeMy WebLinkAboutDrain Layers Permit 17 Karen Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS /7
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT0 451.4
19
Pursuant to written application, permission is hereby` ranted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by
whose address is
Lay for House Drain, Repair House Drain, La Main and to
y Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this p�-rmit*
WASTES ux SANITARY SEW*OE INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Lic ense No C�1/s 7- (�
Z6)2 2 L . 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 in t e name the Town of South Windsor:
Engin ering Department 7 Date
Connection Charge Paid ?G71 �? /� Permit Fee: Paid $ f /1, L
-> 41
Check Numb r-
!ALL
Issued by '
Tax Office
INSPECTION
Date work started
S-uff-ic-iont--- notification received: Date completed -
Yes - - No - -
Special Conditions
APPROVED:
Inspector Date