HomeMy WebLinkAboutDrain Layers Permit 28 Maple Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ` 0 S
38
Pursuant to written application, permission is hereby granted to the
Licen ed Drain tayer named herein to perform the work indicated below at
a L� at premises owned by sal
whose address is a vim— and to
Lay House D ai , Repair House Drain, Lay Main, Other ,
for kt-,j .�T)'C% I occupancy or use, with 2
Family Units , with _acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ,
,INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with yff
_'�
Show sketch of proposed work or furnish two (2) copies of separate drawings.
r^'l
/V J
P
SPECIAL CONDITIONS
C W(2--7
Desired Starting Date � ) p Estimat d Time for Completion / 7Z.
r� �tl1nN�-- Cz V U F S
Permit to be issued to _,,.r a A
the holder of Drain Layer' s License No. 0 .. 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
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory b nd and insurance policy in the
name of the Town of South Windsor:
7u=e
ing Dept. Date
Permit Fee Paid $ -�iUC� Ch ck 7 Z-Z_
Connection Charge Receipt. No. ated
Issued by -
71 T
INSPECTION
Date work started �'Z� v Date completed '��''' '
Sufficient notification rece ve : yes No
Special Conditions
APPROVED:
Inspector Date