HomeMy WebLinkAboutDrain Layers Permit 67 Kupchunos Drive TOWN OF SOUTH WI N DSOR /
DEPARTMENT OF PUBLIC WORKS 7
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4523
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Pursuant to written application, permission is reb granted,tothe.Licensed. I}rain Layer
named herein to perform the work,';ndicat:e( -below at
at premises owned by '�-- Ili j' } ., 1zS 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 Sew�:ge to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES PO, OR Q� 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. Z o h z og . 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. J � ,
Signed
Licensed Drain i'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 wn of South Windsor:
/ 4� —v`7
Enginee ing Depart ent Date
f
Connection Charge Paid" �" � j "J/ 10/ Permit 'Fee: Paid
Check Number ( "
} ✓-r , , / �� t-�C _ Issued by
,Tax Off
IN PEC ON
_
Date work started Date completed
Sufficient notification-received: Yes No
Special- Conditions
APPROVED:
Inspector pate