HomeMy WebLinkAboutDrain Layers Permit 110 Niederwerfer Roa (2) TOWN OV- OUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5760
MAY "t 1992
Pursuant to written application, permission is hereby granted to the
iLicensed Drain Layer named herein to .perform the work indicated below at
1�() lNF�Ipetw6QFre. at premises owned by f{j/'Ea= —UQEtocvA►J
whose 'addfess is I Neim---y-weYuN12 Q;> S.WINDsn2 ,c-r. and to �C
Lay House Dr-ain, Repair House Drain, _Lay Main, Other ,
for occupancy or use, with
Family Units , with acres.
Type of Sewage to be connected under this per SANITARY SEWAGE (}� ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with —3(a� P�pr=_ v
Show sketch of proposed work or furnish two (2) copies of separate drawings.
FEEUv77Fi�T� ��o2 77- Wo Zr� //\J 5 77Ztx-,
SPECIAL CONDITIONS LrsOJT PIZ,# z-4-Z >' �o
Desired StartingDate 1
MAC 199Z Estimated Time for Completion 3ODgy,
Permit to be issued to �pH�J GAVely.
the holder of Drain Layer's License No. 9o3-bqq 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 . StUaQ and/or
CHD Permit No.
. Signed
L i c ed ai yer
The above named Drain Layer has a .va id license issued by the State of
Connecticut and has filed a satisfactory bono and insurance policy in the
name of the Town of South Windsor
z
_ E g"nee i Dept.! Date
Permit Fee Paid $ iQ U Check Number
Connection Charge Receipt No. A-I--0 hDated 517/1 Z.
Issued by
INSPECTION
Date work started Date completed
Sufficient notification received : Yes No
Special Conditions
APPROVED:
Inspector Date