HomeMy WebLinkAboutDrain Layers Permit 1055 Main Street - - - TOWN - OF SOUTH- WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT NNO, 4 9 6 8
Pursuant to written application, permission is here gr ed to t1?vjLicensed Drain Layer
named herein to perfo the ork indic ted .below at Lo n Q-7t-e-.R
at premises owned by k,
6L-Awhose 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
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain La3fer 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�� (
Licensed 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:
Engineering 15epa4tment Date
Connection Charge Paid-*4?6 7 Permit Fee: Paid $ Q 0
a
C ck Number
r Issued by 1 '( 0 AC
Tax f�ffice -
INSPECTION
-- Date work started- Date completed f fl P
Sufficient notification received: es No -�
Special Conditions
APPROVED:
nspector