HomeMy WebLinkAboutDrain Layers Permit 64 Perrin Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
Aa r,
DRAIN LAYER'S PERMIT 4 i 0 4 zi
19 J/
Pursuant to written application, permission is he j;eb grante ,to the Licensed Drain Layer
named herein to perform the work indic ed below at L_� f®
at premises_owne� b whose addre s 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 of , 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 for Completion ;
Permit to be issued to
the holder of Drain Layer's License No. Zaf V( 4--; 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.
7t-Signed
L �
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the Statp of Connecticut and
has filed a satisfactory bond and insurance policq\ in he name of_t4e lfown of Sout Win sor:
% Engineers g`Dgpartment Date
Connection Charge Paid ;' �j`�< !Permit Fee: Paid $ Z--_`
Check Number
Issued b
Tax Office
*INSPECTION
Date work started `— ( Date completed — 7�9`
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Da e