HomeMy WebLinkAboutDrain Layers Permit 41, 43, 45, 47, 49, TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Nam. 4975
19
Pursuant to written application, permission is hereby granted to the,,Licensee Drain Layer
named herein to perform the c0 Wndicated b ow at �� �' 3�-Vi,,�,, ?I�
at premises owned by � ,�LG ��rn�-f 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 drawin
1+34 p� o �
�f 1
3� Ll� � '/
�g5
SPECIAL CONDITIONS
Desired Starting Date EZ -ol - 6-7 Estimated Time for Completion C�,j -t.5
Permit to be issued to ` ��2{ �J� �Z Go.
the holder of Drain Layer's License No. Permit will e pire 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- hereof. Applicant has received
Town Permit No. and/or CHD Permit No.
SignedLicensed Drain Drain Layer
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:
Engineering Department Date
Connection Charge Paid ��'l7i" L;1 Permit Fee: Paid $ J
// �U
_. Check Number JY 2_
�' ✓l!/wit_ (..��'7/ (iG Is-sued by �
Tax Office
INSPECTION
ate work_ started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate