HomeMy WebLinkAboutDrain Layers Permit 91 Mark Drive j
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT { 5 211
19 'j, 5
Pursuant to written application, permission is hereby granted o� he Licensed Drain Layer
named herein to perform the work indicatgd below at
at premises owned by 1` = -�` ( .�
� 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 under this permit: SANITARY SEWAGE ,
(�) INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
f' S1
Show sketch of proposed work or,� f.urnish two (2) copies of separate drawings.
ADIT
SPECIAL CS
Desired Starting Date 7 7 `
r 7 Estimated Time for Completion P 1 L 1.
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 DrainLayer 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.
L: ense-d 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 �/( 6- 7 �(� C1 9 Permit Fee: Paid $ 'J
Check Number JG =�
f -
' Issued by
i
Tax Office /
INSPECTION
Date work started 5-.03 -- E?C Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate