HomeMy WebLinkAboutDrain Layers Permit 1576 Main Street TOWN OF SOUTH - W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT . y �"
192
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work ind?i.cated below at Y76 WO I 5
at premises owned by %.G �r G� , whose address is
"5(A i , and to
Lay House DW-i
n, � Repair House Drain, Lay Main, Other ,
for ;CV;-\F occupancy or use, with
Family Units, with �— acres.
ype of Sewage to be connected under this permit: SANITARY SEWAGE , INDUSTRIAL
WASTES ( ), OR ( Connection will be made with
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j
Show sketch of ptoposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS 47
Desired Starting Date // / `- Estimated Time for Completion
l
Permit to be issued to —�I�t;�.L,S ,Ql),Wle-�
the holder of Drain Layer's License No. 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
Licbnsed 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 epartment Date
Connection Charge Paid4' ` �!.�I' Permit Fee: Paid $ ;�Y/
`-t Check Number
Issued by
Tax Office -�
INSPECTION
Date
--ark-started-_ --- - --�2 9�I Irate complete3-- ---- ------- ----
Sufficient notification received: yYes No
Special Conditions
od
APPROVED: 9; 2 1 - 9 /
Inspector pate