HomeMy WebLinkAboutDrain Layers Permit 44 Goose Nest 371 7' 77-
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TOWNOF SOUTH WINDSOR
I
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 07 10 4989
N 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work=' rd' ated below at L-lctl
at premises owned by ose address is
d 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 )2-6k- E? Estimated Time for Completion .
. Permit to be issued to j '5(,47;r_Q_ Cbos-c 3), 11j C'
the holder of Drain Layer's License No. Z477 Permit will expii-e 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 thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed�
�Licensed brain 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:
Engin-6et'ThEg Department Date
Connection Ch ge Paid Permit Fee: Paid $
40 Check Number
Issued by
'A YL
Tax Office
INSPECTION
Date-work started Date completed
Sufficient notification received: Yes No
--special Conditions
APPROVED:
Inspector Date