HomeMy WebLinkAboutDrain Layers Permit 68 Kingfisher Circle F
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
pRAIN LAYER'S PERMIT o, 4 9 9 9
19
Pursuant to written application, permission is hereb grantCd to the I��ensed ry Layer
named herein to perform the wor 'dated below a �/ /
at premises owned by :���` ,,. whoVo
ddress is
and
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 (L -UI- �] ' I Estimated Time for Completion 3 ► oo�4-S
Permit to be issued to j f'C 5L 1 t-f � S T.li 1&13��.
the holder of Drain Layer's License No. 2-61 7`{ f . 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 de thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
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 Chargg Paid �� G/ tS 7 Permit Fee: Paid $
% Check Number -- —
Issued by
Tax Office
� 7)
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate