HomeMy WebLinkAboutDrain Layers Permit 22 Elderberry Lane / `�.�fl g;^ „"t-a 4 • 1 ��:'`�iY'may�---v _ _ - G M
TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
t" o 5858
0� ') DRAIN LAYER'S PERMIT
Pursuant to. written application, permission is hereby gr.4ted to the
Licensed Drain Layer named herein to perform the work indicated below at
zc--/ Z2 ; atmises owned by 1 --2c slalal
whose address is o 1 re
of - /e(IiA 1C�4 and to
k Lay Hous� Drain, Repair House Drain, Lay Main, Other . ,
for f hiS % occupancy or use, with
' Family Units, with acres.
s
Type of Sewage to be connect-ed under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR. ( )
Connection will be made with U L
Show sketch of proposed work or furnish two (2) copies of separate drawings..
ri
®SHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired 'Starting :Date 0 (A, , 2►, IS q-L Estimated Time for Cgmpletion 1 1_5
Permit to be issued to �� C� ►�`Z
the holder of Drain _Layer's License No. oSk Permit will- expire thirty_.__
(30) days after date of. issuance. The undersigned Drain Layer hereby agrees
to all the terms and co.nditions. set. forth in the permit and the reverse side
thereof. Applicant has received -Town Permit No. a 0 2 - k and/or
CHD Permit No .
51 g n e d
,Licen d Drain aye
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' Windsort
Engineering Dept. Date.
Permit Fee,, Paid $ ' a"j.w Check Number
Connection Charge " Receipt No. L] Dated' O--\C'go`Z.
Issued by
INSPECTION
Date work started Date completed
Z'
Sufficient notifica on ece ea:
- es No
Special Conditions
APPROV `a�2!-9 �
Inspector Date.