HomeMy WebLinkAboutDrain Layers Permit 173 Natsisky Farm Ro TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ®1,. 5083
i73 fW-13isi m kd z _ , 19S-9
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform t e work indicAted elow at
at premises owned by1661
whose address is
Lay House Drain, Repair House Drain, La Main and to
for y Other
,
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit:
WASTES SANITARY SEWAGE ( ), INDUSTRIAL
( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
SDesired Starting Date Estimated Time
for Completion
Permit to be issued to m -=►
the holder of Drain Layer's License'No,.'2.o G
�2--`? Permit will expire thirty (30) days
after date of issuance. The undersigned Dra7 Layer hereby agrees to all the term and
conditions set forth in the permit and the reverse side thereof. Ap licant has r ceived
Town Permit No, and/or CHD Permit No.
i
Signed
is e Dra n Lay '
The above named Drain Layer has a valid license issued by t e State of Q necticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Cha.5g.e---Md " �V, �7
r-- Permit Fee: Paid $
Chec m6er �i/f%G
�/' / y
'� - �r Issued by
Tax Office
INSPECTION
Date work started t�
7 G Date completed �i
*Sufficient notification received: Yes No
Special Conditions
-
APPROVED: -
Inspecto pate