HomeMy WebLinkAboutDrain Layers Permit 1752 Main Street � - TOWN OF SOUTH WI N DSOR
\1� DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 9
Pursuant to written application, permission is hereby granted to_,t�}�e Licensed Drain Layer
named herein to perforn)the work 'ndicated below at f� 2 MJA(k 7S-T
at premises owned by . 1 0 R-Ee - , OILS) whose address is
!-T5Z- M 41 14 T' `j DSO RL and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for -)/Z H+Pr1(" occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE 0<), INDUSTRIAL
WASTES ( ), OR (,l) Connection will be made with
/
V`, �Y -
Show sketch of proposed work or furnish two (2 copies of separate drawings.
y�Il.B Pu`'it.0
6)01300� LAT.-
SPECIAL CONDITIONS M'AIU S�
Desired Starting Date �Zr G{ Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. -Z-,0`7-7 _ Permit will expire thirty (30) days
Y
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse ideI"thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed (\
j' Licensedi Drain Layer
The above named Drain Layer has a valid liceri'e issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ins he name, of the Town of South Windsor:
( kz,: ! 2 Jl 19
Eng ineeftrie Department D to
Connection Charge Paid-4�- Permit Fee: Paid $ ;,�S•C��'
C� Check Number l 1
Issued by
Tax Office
INSPECTION
Z — --- - -
- - date--work start ed --
- ----- ------
Sufficient notification received: 0-' Yes No
Special Conditions
APPROVED:, Z
Inspector Date