HomeMy WebLinkAboutDrain Layers Permit 32, 34 Goose Nest WV
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , 4978
U 19
Pursuant to written application, permission is here y granted to the Licensed�lDrain Layer
named herein to perform the w in icated bel at J 'k
at premises owned by <'__ �� whose address
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) cop4PIS of rate drawings.s
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SPECIAL CONDITIONS
Desired Starting Date i -(.A- -7 Estimated Time for Completion
Permit to be issued to j ` k{ )tA"f&L C .
the holder of Drain Layer's License No. Zol 7 y{ 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 sil thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
T Licensed Drain Layer
r
The above named Drain Layer has a valid liceri4e 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 (Z /,/ Permit Fee: Paid $
' Check Number `f Z-
Issued by
- Tax Office r
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date