HomeMy WebLinkAboutDrain Layers Permit Patria Road (Parcel TOWN OF SOUTH WI N DSOR
fig (( DEPARTMENT OF PUBLIC WORKS
�jX 1 BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4554
1 19-
Pursuant to written application, permission is hereby gr�aj to to Q t Licensed Drain Layer
named herein to perform the ork in#cate below at
at premises owned by whose address is
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 ( ), INDUSTRIAL
WASTES ( ) , OR ( ) Connection 'll be made with
Show sketch of proposed work or furnish two (2) copies of separate drawing .
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to ► ojNt AL M i2r rZ�.r c 1Nc
the holder of Drain Layer's License No.;� , �j_2r,� ) . Permit will expire thirty (30) days
after date of issuance. The undersigned Drain La*er 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 � �-%�
Liceh6ed Drain Layer
The above named Drain Layer has a valid license issued by thelState of Connecticut and
has filed a satisfactory bond'and insurance policy in -the ndme' of the Town of South Windsor:
i
Enguneering Depart
,�ent Date
Connection Large Paid / 3 (f 2-Z� - Permit Fee: Paid $ ry Z 3 k
Check Number,_
r Issued byVV
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date