HomeMy WebLinkAboutDrain Layers Permit 70, 72 Kingfisher Ci 7717
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO, 5000
Pursuant to written application, permission is hereb granted to the Licensed Dr in Layer
named herein to perform the work- )4icated Belo at Z
at premises owned by %= whose addre s
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.
65 - 7 G C
7a
SPECIAL CONDITIONS
Desired Starting Date 12--p}- t;J Estimated Time for Completion
Permit to be issued to Ij C,
the holder of Drain Layer's License No. 20-7 7LF9 Permit will expi a 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 sid ereof. Applicant has recei
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:
Eng' Bering Department Date
Connection Charge Paid (j Permit Fee: Paid $
Check NumberA,1,4 Z -
Issued by
Tax Office -
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
_ Sp_ecial Conditions
APPROVED:
Inspector Date