HomeMy WebLinkAboutDrain Layers Permit 68 Meryl Road TOWN OF SOUTH WINOSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT _
Pursuant to written application, permission is h reby rant a Licensed Drain Layer
named herein to perform the w2rk indicat: d b low:at
at premises owned by �� rpJ-/ _ whose;,address is
and to. -
Lay House Drain, 'Repair House Drain,' ` 'Lay Main, Othdr ,
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
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired, Starting Date Estimated Time ,for Completion
Permit to be issued to G
the holder of Drairi: Layer's License N6.. Permit w .- ire t in (SO')' days
after date of issuance. The undersigned Drain Layer hereby agree 1 terins.;and
conditions set forth in the permit and the reverse side thereof. Applica " ive
Town Permit No-. .J - and/or .CHD_Permit, No.
,..Si ed / .
- Licensed 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`S'outh;Windsor:
Engineering Depalitment Date
Connection Charge Paid -//06,0 y Permit Pee: Paid $ Xf) "6o
Check Number a
InqAtt-c- Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date