HomeMy WebLinkAboutDrain Layers Permit 22 Linda Lane TOWN OF SOUTH WINDSOR
, ✓ � �; DEPARTMENT OF PUBLIC WORKS
l� BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N O 5815
� `r /c) c- 19
Pursuant toa written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by
whose address is 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 (4
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings .
I ! ' .,lTr,
SPECIAL CONDITIONS Z-L G r�t.� 1 �� is�`�' {%�; ' i_S; ,C,
Desired Starting Date :,/ Estimated Time for Completion
,r
Permit to be issued to T
the holder of Drain Layer ' s License No. t 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 side
thereof . Applicant has received Town Permit No . and/or
CHD Permit No .
Signed :
licens,o 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 :
rEnginee. 'ng Dept. Date
Permit Fee Paid $ �.. Check,, Number �� �`�`11' C
Connection Charge Receipt No. — Dated --
Issued by
{
INSPECTION +
Date work started Date completed
Sufficient notification received : es No
Special Conditions
APPROVED:
Inspector Date