HomeMy WebLinkAboutDrain Layers Permit 20 Quail Run TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ND 5464
p10 1 -,�l�a , 19
Pursuant to written application, permission is her„gb� granted to the Licensed Dr in�yer
named herein to perform the work indicated �elow at cY- rj ab tih-e—
at premises owned by �p,� s 7� whose address is
ST 12 Jand 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 (�), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time
eeJ-for Completion
Permit to be issued to
the holder of Drain Layer's License No. 20 P�lr Z 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. and/or CHD Permit No.
Signed
�7�"��"' 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 Department Date
Connection Charge Paid 7 f 9 Permit Fee: Paid $ oR5 U0
C1 Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date