HomeMy WebLinkAboutDrain Layers Permit 57 Krawski Drive .:
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT7p 4130
5 qY /r V
Pursuant to written a � ' r' 19 L—I'L
named herein to erform. PPlication, permission is hereby granted to the Licensed Drain Layer
at premises owned by � "�/
Lay House Drain, whose address is
for ----_ Repair House Drain, and to
Lay Main' —_ Other
Family Units, with occupancy or use, with '
acres. ---
Type of Sewage to be connected under WASTES
• IAL
Connection will be made
w
h
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date
Estimated Time—for Completion
Permit to be issued to
the holder of Drain Layer's License No. —_.
after"date of issuance. The undersigned Drain Layer hereby agrees will expire thirt conditions set forth in the permit and the reverse side thereof, y (30) days
y agrees to all the terms and
Town Permit No. and/or CHD Permit No. APPlicant has received
---------------
Signed
The -above named Drain Layer has a valid license issue Licensed Drain Layer
has filed a satisfactory bond and insurance policyd by the State of Connecticut and
in the name of the Town of South Windsor:
y-
Engineering Depar ent
Connection Charge Paid Date
—�(� } "dU Permit Fee: Paid
Check Number
Issued by
Tax office
INSPECTION
Sufficient notification
Date work started
-received: Date completed -- -
ecial Conditions Yes No
APPROVED:
Inspector
Date