HomeMy WebLinkAboutDrain Layers Permit 58 Norton Lane TOWN ..OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
N o 5797
F DRAIN LAYERS PERMIT ,,
\IJUA1E 0 � 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work ind cated below at
at premises owned by
J
whose address is and to
Lay House Drain, Repair ' Hou.se 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
Show sketch of p-roposed work or furnish two (2) copies of separate drawings,
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S�PE ,ZA C Nbi IONS
Desi Cd�� .in& 4a to - 7/ ,ZEstimated Time for Completion
Perm issued to S#�waor�
the holder . Drain Layer's License No. Permit will expire thirty
(30) days after date -of issuance. , The undersigned Drain Layer hereby agrees
to l the terms and conditions s"et forth in the permit a*hd the reverse side
thereof. Applicant has received• 'Town Permit No. 3 / and/or
CHD Permit No. �,•;'
Sig'ne,d: ell
Licensed Drain Layer
The above named ' Drain' Layer has a valid license issued by the State of
Connecticut and hoas� file,d:••,a satisfactory. bond and insurance policy in the
ILname of the Town 'of ,South Windsor:
E g: n ng Dept. Date
Permit Fee Paid $ 25.O.O Che k umber.
Connection Charge Receipt No. I .R Dated. le 5C5 \ g
Issued by
7/ (\A
INSPECTION
Date work started ate completed
Sufficient notifica on rece ve es No
Special Conditions
APPROVE
. IrispecCdf Date
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