HomeMy WebLinkAboutDrain Layers Permit 64 Kingfisher Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Xobl. 4997
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19 -�
Pursuant to written application, permission is he eby granted to the L cerise Drain Layer
named herein to perform the work ii ic,�ted below at _ ;'
at premises owned by , - Q- wh address is
a 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 IZ-01- gJ? Estimated Time for Completion --5 rNU�JT'1�5
Permit to be issued to J 14 -15uppt C'Ojssr C loos
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' a hereof. Applicant has received
Town Permit No. and/or CHD Permit No.
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Signed
i Licensed Dr in Layer
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The above named Drain Layer has a valid licen a issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
/z -/= 2
Engineeritrg partment Date
Connection Char e Paid
g � /./ G. , Permit Fee: Paid $
Check Number—
Issued by
Tax Office
INSPECTION
-- --- ----- -
Date work started Date completed
Sufficient notification received: Yes No
__- _____Special Conditions
APPROVED:
Inspector pate