HomeMy WebLinkAboutDrain Layers Permit 880 Main Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6'
Pursuant to written application, permission is hereby granted to the__ cen d Drain Layer
named herein to perform t work indi,,cate,d—he t
at premises owned by L` /i�/�jj7 �� 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 ( , INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
t
C
Show sketch of proposed work or furnish ie of separate ra s.
U ,
SPECIAL CONDITIONS Af
Desired Starting Date 41 Estimate Time for Completion l S~
Permit to be issued to
the holder of Drain Layer's License will expire thirty (30) days
y
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 thereg7 Applicant h received
Town Permit No. and/or CHD Permit No.
Signed
Licen ed 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:
ngineeiing Department Date
Connection Charge Paid {/C,. Permit Fee: Paid $
o
Check Number
J �i
Issued by `' l
Tax Office -
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: _
Inspector ^ pate
Paul M. Surber Co.
PO Box 93 /
So. Windsor, Conn. 06074 �
( 203) 289-1497
Mildred Aleshin 880 Main Street Sanitary Sewer connection as-built
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