HomeMy WebLinkAboutDrain Layers Permit 20 Kelly Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT !122 5282
19 , 1
Pursuant to written application, permission is hereby rante (to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by l;{�-:�t t.y d'V whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work o_lr furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Est' ted 'me for Completion
Permit to be issued to F
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigns Drain Layer hereby agrees o 11 the termsand
conditions set forth in the permit and the reverse side thereof. �' li a t has received
Town Permit No. and/or CHD Permit No.
Signed
'censed raLAver
The above named Drain Layer has a valid license issu d by Le S to Connecticut and
has filed a satisfactory bond and insurance policy in the name of the To of South Windsor:
Engineering a went Date
Connection Charge Paid j/GNU UU Permit Fee: Paid
Check Number
Issued by
4 Tax Office
INSPECTION
-Date work started 8.,_ Date completed
Sufficient notification re eiv d: Yes No --v
Special Conditions °
APPROVED:
nspector Date