HomeMy WebLinkAboutDrain Layers Permit 169 Kent Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5368
l�� / I-A,I /i- a , 19,5-9
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at L-or -6 KE�tr �f}N
at premises owned by ( ( ¢ �(� << whose address is
1HAMC C,..,, and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for C„j&,P 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 or furnish two (2) copies of separate drawings.
' i IOUSr �GJ AB-
A 7z S 6
�-,. A"r /j•. 'F1eoM TOP OF-AI
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Kti LA.
SPECIAL CONDITIONS
Desired Starting Date W k 13•rt, Estimated Time for Completion T)-1
Permit to be issued to Ac Pa,,, 1,,,
the holder of Drain Layer's License No. W F¢1t, Permit will expire thirty (30) days
Y
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. Applic nt has received
Town Permit No. and/or CHD Permit No.
Signed
Licens-er rain Layer
The above named Drain Layer has a valid license issu �d y the State of Connecticut and
has filed a satisfactory bond and insurance policy in the ame of the Town of South Windsor:
Engin ering Department Date
Connection Charge Paid Permit Fee: Paid $ /S.4CU
Check Number
f: Issued by
W Of fide
.`t
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date