HomeMy WebLinkAboutDrain Layers Permit 42 Goose Nest TOWN OF, SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
] DRAIN LAYER'S PERMIT 1�N 4988
d , 191
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work Indicated below at �, Z
at premises owned by 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.
1
SPECIAL CONDITIONS
Desired Starting Date Iz-W- Estimated Time for Completion 3 yl0rjFt}S
Permit to be issued to �� �j( ( j(,js , (I. (/,)C.
the holder of Drain Layer's License No. 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 s thereof. Applicant has rersived
Town Permit No. and/or CHD Permit No. t�
Signed,
Licensed Drain Layer
J
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 ;/ b/Z) �/ ? Permit Fee: Paid $ -j
- Check Number
Issued byf --�
ax office
INSPECTION
Date wor starter 'Bate completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date