HomeMy WebLinkAboutDrain Layers Permit 33 Karen Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4739
19
Pursuant to written application, permission is hereby granted to th Licensed rain Layer
named herein to perform the work indicated below at 4/0' ID
at premises owned by , r -��
whose address is
Lay House Drain, Repair House S Drain, and to
for Lay Main, Other Fa occupancy or use, with
Fain y nits, with acres.
U
Type of Sewage to be connected under
WASTES OR ), STRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date -/ - 7 Estimated Time for Completion b-
Permit to be issued to
the holder of Drain Layer's License No
after date of issuance. The undersigned
Drain Layer hereby agrees xtorallhtheyterms ands
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 the name of the Town of South Windsor:
En ineeri "g Department Date
Connection Charge Paid �1 6 D c; v Permit Fee: Paid U y
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date compiet_ed ___- {_ ,,
- --Su-f-f-ic3en�notification received' Yes �! / zZ,7
Special Conditions No
APPROVED*
Inspector Date