HomeMy WebLinkAboutDrain Layers Permit 25 Perrin Lane 777
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
qe-< DRAIN LAYER'S PERMIT "6 �/`
a . . L 19 `
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicatd below at
_
at premises owne by Tl-�S ti whose address is
r r e �//- �,,
and to
Lay House Draiii, 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 (A-, 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 - Z- 6 Estimated Time for Completion g. z 6
Permit to be issued to �r`Pl` �G�r/.
the holder of Drain Layer's License No. t y�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 ,
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
L
Connection Charge Paid
� "'7 �"� Permit Fee: Paid $ '�
Check Numbed
Issued by
Tax Office
INSPECTION
Date work started qj Z$ Date completedj �
Sufficient notification received: Yes No
Special Conditions
APPROVED:
nspe for Date