HomeMy WebLinkAboutDrain Layers Permit 1562 Main Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a'3
19�:
Pursuant to written application, permission is hereby granted-t—Sd" the Licensed Drain Layer
named herein to perform the work dicated below at
at premises owned by ` o ��. whose address is
(,, and to
Lay House Drain, Je Repair House Drain, Lay Main, Other ,
for f> > X occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (X), INDUSTRIAL
WASTES ( ), OR (�) Connection will be made with
f� L' —A, I
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS �yl jY"d;V P
Desired Starting Date _T Estimated Time for Completion
Permit to be issued to ;�1i1 t La P ""M,
the holder of Drain Layer's License No. c� . Permit will expire thirty (30) days
after date of issuance The undersigned Drain L yer 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/r G.t Owe.•
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 Department Date
Connection Charge Paid ��;���k( Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date started— -Date completes
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate