HomeMy WebLinkAboutDrain Layers Permit 21 Larkspur Lane �
TOWN OF SOUTH WI N DSOR �01, -.
DEPARTMENT OF PUBLIC WORKS 'a
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3764
Pursuant to written application, permission is hereby grante to the Licensed Drain Layer
named herein to perform the w_o k 'ndicat.ed below at:
at premises ,owned .by Ott-F whose: address is
'and.,to-,
Lay House Drain, Repair` House Drain, Lay Main, Other, ,
for o'ccupaiicy or use;` with
Family Units, with acres.
L
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'iwo (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated--Time for Completion
Permit- to be issued- to -
the holder of Drain Layer's.-Uicense NO'i, Permit will expire"thirty (30) days
after date of issuance The undersigned Dra— Layer he'reby'agrees '.to 'all the termi.and
conditions set forth in the permit and the reverse side thereof. Applicant has _received
Town Permit No: :and/or ,CRD Permit. No. . .
Signed
- Licensed Drain- Layer
The above named: brain Layer has a valid ,license .issued' by`�the State''of"`'tonne`cffcut and
has filed a satisfacto-ry bond and insurance ppl�cy' .the of 'the wn of;South Windsor:
r
Engineering-::Department� Date
Connection Charge Paid 0,0( " Permit Fed:-,* 'Maid �
Check Number /1110
3,jj/11 v(c Q Issued by
Tax Office 1 � -
LZILL&L 2�, �-1 Gte y2GCS2
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
-Special Conditions
APPROVED:
Inspector Date