HomeMy WebLinkAboutDrain Layers Permit 1155 Main Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5221
-8/ , 190T
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform he o k Indic d be ow at .�L '
at premises owned by 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 unde�t�h� (A)--, INDUSTRIAL
WASTES ( ), OR ( ) rr /P'� !/_( ` Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
c-X, ST
ef
IV 600
SPECIAL CONDITIONS
Desired Starting Date Est'mated. Time for Completion Z - Z
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 tayer 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. f
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 ame of the Town of South Windsor:
6leq
Engineering epartment Dat
Connection Charge Paid - ��,�U Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
a e wor started-- - 2a g ---Date completed -
Sufficient notification received: _ Yes No
Special Conditions
APPROVED:
Inspector pate