HomeMy WebLinkAboutDrain Layers Permit 80 Kimberly Drive g 32, TOWN OF SOUTH WI N DSOR
�I DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Vim'" �ly
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at `4, r # l�, ,�,rr,c=X rr
at premises owned b r' -�
y /1r � < _ , s r"�� Z 'whose address is
La House Drain and to
3' , Repair House Drain, Lay Main, Other for " � f ; •<ra,7:
R St occupancy or use, with Family Units, with acres. �—
Type of Sewage to be connected under t is—permit-SAPdiTARY SEWAGE INDTTS IAL
WASTES (;r, OR ( ) Connection will be made with
Show sketch of proposed work or furnish tw, 2) copies of separate drawings.
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SPE�IAL CONDITIONS
Desired Starting Date to Estimated Time for Co m letion
p ....`l/s c•� .�b
Permit to be issued to c",4 T
the holder of Drain Layer's License No. 's, Z?y 3 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
Town Permit No. and/or CHD Permit No.
1 /!
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:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid v
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed _
- --Suffi-ci-ent notification- received. Yes No
Special Conditions
APPROVED: _
Inspec Ate