HomeMy WebLinkAboutDrain Layers Permit 10 Meryl Road (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
5732
DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicate below at
"X-A. � at premises owned by
whose address is and, to
Lay House Drain, Repair House Drain, 'Lay Main, Other
for oc.cupancy or use, with
f Family Units, with f- acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separatdraw ngs_,
sneer f32 a
SPECIAL: CONDITIONS
Desired Starting Date 3 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layerfs License No. 'Z 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 an the revexse side
thereof. Applicant has received Town Permit No . d/or
CHD Permit No.
Signed/<01
L ensed Drain er
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory onid and insurance policy in the
name of the Town of South Windsor :
--
inee Dept. Date
Permit Fee Paid $ Z��-DU ChecQ N mber
Connection Charge Receipt No. 1 3 Dated 3127/9 Z
a 4;
Issued by
INSPECTION
Date work started 30 9 2— Date completed 3- 3
0 -9
Sufficient notification received: '—des No
Special Conditions
APPROVED• 3�34- 2
Inspector Date