HomeMy WebLinkAboutDrain Layers Permit 34, 36 Goose Nest TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4985
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Pursuant to written application, permission is hereb granted to the Licensed rain La er_
named herein to perform the work inr 'ca ed below at Y 7- X j'-1
at premises owned by / whose dress 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.
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SPECIAL CONDITIONS
Desired Starting Date +2 -y)-c� Estimated Time for Completion Jiyjpl(JTS
Permit to be issued to J 4 14
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the holder of Drain Layer's License No. 2���t_q 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 siftf thereof. Applicant has received
Town Permit No. and/or CHD Permit No, �.
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Signed
Licensed 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 Permit Fee: Paid $
f Check Number �.
Issued by
Tax Office �
INSPECTION
Date work started-.- -
Aate completed
Sufficient notification received: Yes No
Special Conditions _.
APPROVED:
Inspector Date