HomeMy WebLinkAboutDrain Layers Permit 993 Main Street DEPARTMENT OF PUBLIC WORDS
BUREAU OF POLLUTION CONTROL
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17 , 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work ind.icated below at
T at premises owned by f 2u.c.(i. C, JIf?C
whose address is and to
Lay House Drain, Repair House Drain, Lay Main., Other ,
for occupancy or use, with
t
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ,
I. INDUSTRIAL WASTES ( ) , OR { , ),
Connection will be made with i k
Show sketch of proposed work or furnish two (2) copies of separate drawings. '
Ex!sr� C. I. l�
�Krs i
SPECIAL CONDITIONS
Desired Starting' Date 77
Z Estimated Time' for Completion /
Permit to be' issued to a•cgI"
the holder of Drain Layer' s License No. 7677 Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions set forth the permit and the reverse side 1
thereof. Applicant has received Town Per it o. And/ r
CHD Permit No. -
Signed .
censed Drain Layer
The above named Drain Lay'er :h;as a va d license issued by . the State of
Connecticut and has, filed ' a 'satisfactory o d and insurance policy in the
name of the Town-'of South' Wind:sor:
:Engineering Dept. Date
Permit Fee Paid $ - Check NumberA
Connection Charge Receipt No. t e d 1
7
- Issued'-by ;
INSPECTION
Date work started Z- Date completed � �7
Sufficient notifica on receiveaf yes No -
Special Conditions
- Inspector Date