HomeMy WebLinkAboutDrain Layers Permit 1024 Main Street s ,: s
SOUTH WT►�ncne -
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
-- --- — -- -- - -- - DRAIN LA E PERMIT
- --- --
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named h 02r to perform the work indicated below t
JU�� 41fj � at premises owned by �9lKr �gm
whose address is e) r► A "O S' • . and to
Lay Hous Dr in Repair House Drain, Lay Main, Other ,
for y� �' 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 2 V G p 1A �...
Show sketch of pro osed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS /)arie.
Desired Starting Date 2? Esti. ted Time for Completion -
Permit to be issued to i
the holder of Drain Layer 's License No. 6 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 0,LA
Licensed Drain Layer
The above named Drain Layer has a valid license ,issued by the State of
Connecticut and has filed a satisfactory bo d and insurance policy in the
name of the Town of South Windsor:
E g nee g Dept. Date
Permit Fee Paid $ 2 � Check u ber
Connection Charge Receipt No. � ated '� J
Issued by 4h
INSPECTION
Date work started �r _g Date completed '/-2 Z
Sufficient notificationAriacelea: ,f f yes No
Special Conditions
APPROV -
Inspector Date