HomeMy WebLinkAboutDrain Layers Permit 82 Sandpiper Place ... \ ,. < gar• .:... . .. ..... �F::t r�,r..�#�+.h'•:YxL , r�:;. s' _ T.". .. .. ,. _ .,
TOWN OF SOUTH 1
W NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERM 9
Fa 44" JI-1 19` G
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at '7( (_.i}IL Woo
at premises owned by whose address is
17 L-H L.11 1 N�a �'�t J j 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 h, Q
Permit to be issued to S } C r�121L_ C_6wS7', Ln I/JC
the holder of Drain Layer's License No. 02 7 1Permit 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 Drain Layer
v
The above named Drain Layer has a valid li ense�.issued by the State of Connecticut and
has filed a satisfactory bond and insurance pol,, y n the name o he Town of South Windsor:
Department Date
Connection Char a Paid " o g ' �- /' 1 PeInIfine
it Fee: Paid $
C ec�, Number Lf l'; I 1
Issued by ' :J
Tax Office j
INSPECTION 1
--Date work -started -" — Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: _
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