HomeMy WebLinkAboutDrain Layers Permit 50, 52 Goose Nest -
TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 9 91420
/2(> 191 !'
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the wo dicated below at ZZY SSd .SZ _ 5�C —_S L L-ra-e
at premises owned by "t�.��y —r/� 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 furnishtwo (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 12-6I-P,`7 Estimated Time for Completion &Ot,j-nfS
io
Permit to be issued to V 4 11 j LA"Z�P 6 t 57 r C6 k{C
the holder of Drain Layer's License No. Z.07-7yl Permit will expire 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 s d thereof. Applicant has rec�d
Town Permit No. and/or CHD Permit No.
Signed
License r in 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 // 7 Permit Fee: Paid $ i
Check Number
Issued by
Tax Office
INSPECTION
-- -----------
Date wor started Date completed
Sufficient notification received: Yes No
__- Special._Conditions
APPROVED:
Inspector Date