HomeMy WebLinkAboutDrain Layers Permit 27 Kupchunos Drive (3) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 4591
arl XL.LPAwndS nr '
Pursuant to written application, permission is here y grant to t,�j�je----L`icWse Drain Layer
named herein to perform the work icated below at
at premises owned by 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 T'me for Completion
Permit to be issued to
the holder of Drain Layer's License No U6o® Permit wil 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 Q .
Licen Drain Layer
The above named Drain Layer has a valid license issuby the S ate of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
a -13 �f7 A11-1,73 ---3 -/0-0,�)
En ineerin De
g g Department
Date
Connection Charge Paid C,lQQ�� Permit Fee: Paid $
Check Number
Issued by
Tax dffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
of 04,
APPROVED:
Inspector
Y •j- .. r
f.
Ai
IV
i
t-..
i
Ii
5
► y-