HomeMy WebLinkAboutDrain Layers Permit 192 Krawski Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Iota "StQ (Dr...., - ate- 19 5—
Pursuant to written application, permission is here
named herein to perfo a ork indicated below, at ,yy�ranted to the Licensed Drain Layer
at premises owned by "-1 ,... �- ,A�La��J 3
whose address is
Lay House Drain, . `'Repair House Drain, an&to
for Lay Main, Other
Family Units, with a cres. occupancy or .use, with
Type of Sewage to be connected under this permit:
WASTES QR SANITARY SEfn1A6E-F( `, T;._._
—�� - Co nection will be.made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Startingj'Date Estimated Time for Completion
Permit_ to be issued to
the holder of Drain"tdyer's License No "
after date of issuance. The undersigned Drain Layer hereby agrees xtorallh .the terins 'an
ys
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 Co nnecticut 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
$ 16,' oa
Check Number
Issued b
(n Tax Offi
INSPECTION
Date work started
Sufficient notification -received: Yes Date completed
Special Conditions
No
APPROVED:
Inspector pate