HomeMy WebLinkAboutDrain Layers Permit 16 Kupchunos Drive .avnc. ,.-. tr,q..;v""„iV;f='�'r'fF�e..Su6.`n;r✓.+av.•,: tWOW
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT e, 4210
(� - 19�a
Pursuant to wri n a p is l ion, permission is ereby gra ted to the Licensed Drain Layer
named herein to perforp the o indicated below at k ;�� f /; j�
at premises owned by (� /� rJ., 1 ���,h y;� n whose address is
and to
Lay House Drain, Repair House Drain, Lay 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
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. 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.
Signed
Licensed Dra ayer
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:
ngineering Department Date
Connection Charge Paid ,��j�y (,: J G/ Permit Fee: Paid $ J
Check Number
Issued by
V! Tax Office
INSPECTION
ate wor start-" - Date completed
Sufficient notification received: Yes No
_ S ecial Conditions -- - _ - -
APPROVED:
Inspector Date