HomeMy WebLinkAboutDrain Layers Permit 1021 Main Street MM
DEPARTMENT OF PUBLIC ��SOR
BUREAU OF POLLUTION CONTROL
WORKS
CONTROL
- DRAIN LAYER'S PERMIT
L tm 5 "�1
Pursuant
named to written a
herein to perform he work
permission 1
at premises owned b work indicat is he ebY granted Y -'� low at v a to the; icensed
Lay Mouse Drain,f. Drain Layer
for -- Repair House Drain, whose address is
Famil
Y U~ ts, wi Lay Main, and to
--_� acres, oc Other
Y use, with
Pe of Sewaa
WASTES Type
( ) to be connected
under this permit; SANITARY
� SEWAGE
Connection �)' INDUSTRIAL
Show sketch of will be
proposed work or furnish
with
rnish two (2) copies of
separate drawings,
SPECIAL CONDITIONS
Desired � -�
Starting Date
Permit to be issued to Estimated Time for Completion
the holder of Drain re
after date Layer s L cense No. _
of issuance, The undersigned conditions set forth Permit will ex
gned Drain Town Permit No. in the permit and the reverseiaer hereby agrees to all hlrty (30) days
and/or CHD Permit No, side thereof. A the terms and
PPlicant has received
Signed
The above named. Drain Licensed
has filed a satisfactory Layer has a valid Drain Layer
rY bond and insurance license issued b
policy in the Y the .State of Connecticut and
name of the Tom
J' of South Windsor;
Connection '3 f�/` ngineerin �Da
Charge Paid / g DepartmentPermit Fee.
Paid
Check Number
Tax Office Issued by
INSPECTION
at -acted
efficient notification
v
?ecial Conditions receied; Date completed
Yes No
APPROV ;