HomeMy WebLinkAboutDrain Layers Permit 53 Loon Place M-
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO, 4981
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the wor i icated below atC i1 j �T },� _
at premises owned by whose 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 Time for Completion 11-10krM
Permit to be issued to F� l� tt- Czt'j.3c C4. I t,lc
the holder of Drain Layer's License No. 2-rs77LjJ . Permit will xe pire thirty (30) days
Y
after date of issuance. The undersigned Drain Layer -hereby agrees to all the terms and
conditions set forth in the.permit and the reverse sid- thereof. Applicant has received
Town Permit No. and/or CHD Permit No. /
s4 /
Signed r �-c��.,
f Licensed 6rdln Layer
f
The above named Drain Layer has a valid licen' issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Enginee ing Department Date
Connection Charge Paid Permit Fee: Paid $ f�
Check Number
f �a Issued by
Tax Office
INSPECTION
Date work- started Date completed
Sufficient notification received: Yes No
Special_Conditions
APPROVED:
Inspector Date