HomeMy WebLinkAboutDrain Layers Permit Main Line - Lakewood (2) y... rya.'* 4 ? `"'-�'. '6 Jn5Jl'!'xf '�(1 ' ✓YEI.7 �I x5 :} . `
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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT / o, 4853
Pursuant to written application, permission is he5eb granted to the Licensed Drain Layer
named herein to perform thework indicated below at � � W w. Z J .3
at premises owned by whose address is
e
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.
t
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to � �/ ;l j f 7-
the
the holder of Drain Layer's License No. 2c,q- 7V . Permit will expire thirty (30) days
Y
after date of issuance. The undersigned Drain Layer her by agrees to all the terms and
conditions set forth in the permit and the reverse side hereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
' Licensed Drain Layer
1
The above named Drain Layer has a valid liceAse/issued by the State of Connecticut and
has filed a satisfactory bond and insurance polic�yAin name of the Town of South Windsor:
Engineering Department Date
Connection, Charge Paid C_ Permit Fee: Paid $
Check NNmblfiF-_� )
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes: No
-special
APPROVED:
Inspector Date