HomeMy WebLinkAboutDrain Layers Permit 55 Nutmeg Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Au s
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at ,/� "/ .�� .. �� ,
at premises owned by f'l. s S'�Izolc�� whose ad ress is
S' Lw-Z and to
Lay douse Drain, (,,/ Repair House 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 Z)(JL_
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date _T=41— 4?/ Estimated Time for Completi
Permit to be issued to A,f G
the holder of Drain Layer's License No. Permit will e ire thirty (3 ) day
after date of issuance. The undersigns Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side there y>Appliant received
Town Permit No, and/or CHD Permit No.
Signed
License rain 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 South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Z 5 '
- ( ✓�, $ Check Number ZJ 391
Issued by
Tax Office
INSPECTION
Date work started l - 4- ! Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: �f
Inspector Date