HomeMy WebLinkAboutDrain Layers Permit 38 Karen Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Nam. 4889
19
Pursuant to written application, Wermission is hereby granted to the Licensed Drai
named herein to perform the work indicated below at n Layer
at premises owned b r,`
Y �!.���.� whose address is
La House Drain and to
Y Repair House Drain, Lay Main, Other
for �';rrt L
occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under
WASTES ( , OR ) Connection will.be made with
Show sketch of proposed work or furnish t (2) copies of separate drawings.
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vp' 1
SPECIAL CONDITIONS
Desired Starting Date cf %— "7 Estimated Time for Completion
Permit to be issued to TV r (v tir 5 T C a
the holder of Drain Layer's License No. 2f)v 2 2 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
Torun 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: he name f the Town of South Windsor:
z/ '
Engineering Depart t Date
Connection Charge Paid y V Permit Fee: Paid $ ;
Check Number t
Issued by
I
Tax Office
INSPECTION
Date work started Date completed -_-
-- -Sufficient notification received. -- - y
No
Special Conditions
APPROVED: _ 8
Inspector Date