HomeMy WebLinkAboutDrain Layers Permit 68 Parkview Drive I� �0 V TOWN OF SOUTH WINDSOR
/" ' DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1`No. 5 0 0 5
/� /,6 , 19d
Pursuant to written application, permission is here'] gypnted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by > '
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES ( ), OR ( ) INDUSTRIAL
Connection w 1 be made with
Show sketch of proposed work or furnish two
o ies separate dr wi s.
�o
#—A D
l 6g
SPECIAL CONDITIONS
Desired Starting Date Est' ated Time for Completion
1
Permit to be issued to
the holder of Drain Layer's License No.
after date of issuance. The undersigned Drain Layer hereby agreesxtorall they
yterms ands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No, and/or CHD Permit No.
Sigried4a___.4
Licensed 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 policy in the name of the Town of South Windsor:
Engineering Departm �nt Date
Connection Charge Paid �b, Q(� $ L11 �
Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started _ ,7_�9 �'
Sufficient notification eived: Date completed
Special Conditions Yes No
APPROVED: _
Insp ctor pate