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HomeMy WebLinkAboutDrain Layers Permit 195 Kent Lane TOWN. 17 SOUTH W"INDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL' pp AA DRAIN: LAYER'S PERMIT ' N2 5 a�t 2 Pursuant to written application, . permissio.n is hereby granted to the Licensed Drain. L yer .named" herein to perform the work ndi a ed below at L: at p-remises owned by wtiose a dress is and- to Lay House' Drain, Repair 'H se 'Drain I.ay, 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 %f C _ Show sketch of proposed work o urnish two (2) copies of separate drawings. _ _ SP-ECJAL-_CONDITIONS /ZerGa_r__& -&P. LCOWt�. Desired Starting Date /G--_!--Z_ Estimated Time for Completion Permit to be issued to- . the holder of Drain Layer' s License No. Permit twill expire thirtyI (30), 'days., after date of issuance. : The un ersig_ned 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 the name of the Town of South Windsor: n ine rig ,Dept. Dane Permit Fee Paid $' Z -© Q Check umber Connection Charge. Re hZi "ceipt ' No. lLD ated Z �' 1 ,_ L'ssued : by INSPECTION Date work started ZZL/ Date completed Sufficient noti€ica on rece ve : —Yes No ' Special Conditions nspector Date