HomeMy WebLinkAboutDrain Layers Permit 74 Partridge Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT FP,
`7 if 19
Pursuant to written application, permis%ion is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below att�� :'L /
at remises owned by T 't �„if.;� Q1(I +,-, whose address is
1 i`i J4,di S G,�I lcya�Sa fy V L and to
Lay House Drain, G 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 (°C), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
a
SPECI ONDITIONS /;y
Desired Starting Date `0- - Estimated Time for Completion
i
Permit to be issued to
the holder of Drain Layer's License No. 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 �6 � i°'
Licensed Drain Layer
The above named Drain Layer has a valid licenFe issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy'!in th� name of Town of South Windsor:
�5-12�5
En,gineer'n epartment Dane
_ - �� I o d
Connection Charge Paid. _ - ,� \Perm
._ t Fee: Paid $ L
4`eck Nu tuber
Issued by _
Tax Office 7 Qj
INSPECTION
Date work started Date completed f( G
Sufficient notification received: Yes No —�-
Special Conditions
APPROVED:
Inspector Date