HomeMy WebLinkAboutDrain Layers Permit 25 Palmer Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
V, D 196
Pursuant to written application, permission is hereby gr nted to the
Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by 1�I�Q, f��-,,� �c�/ whose address is
'14 X,t and to
Lay House 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 (V5/, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
� J
1
I r
SPECIAL CONDITIONS
Desired Starting Date % - 5 Estimated Time for Completion YJ
Permit to be issued to ,' 1 ✓ �� �Q,�,y C� ,v ,�5� i / �,��j
the holder of Drain Layer's License No. o�Y� Permit wi 1 expire fhirty (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, and/or CHD Permit No.
Signed
Licen ed 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 polio id the name the Town of South Windsor:
,Engine g Department Date
Connection Charge Paid `? -`> _ ',,Permit Fee: Paid $ /,f•CC
Cleo Number 6 5
Issued byTax OfficeOffice
INSPECTION
Date work started GJ^`,o-S ' Date completed Itkv 7-1
Sufficient notification received: ,,,/ Yes No
Special Conditions
APPROVED:
Inspector ate