HomeMy WebLinkAboutDrain Layers Permit 70 Perrin Lane \� TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
8 3
DRAIN LAYER'S PERMITr
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Pursuant to written application, permission is her by gran d to the Licensed Drain Layer
named herein to perform the work indicated below at LL r (_..t:,,e— -0,-70
at premises 0 edi by :5—,VY7 Gv v S i n t . whose address is
and to
Lay House Draid, L,/ 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 el), INDUSTRIAL v-
WASTES ( ), OR ( ) Connection will be made with / L
Show sketch of proposed workor furnish two (2) copies of separate drawings/Ir_
4-�
SPECIAL CONDITIONS
Desired Starting Date `Z/— l Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Z� Pyf L-, 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 is�ued, by the State of Connecticut and
has filed a satisfactory bond and insurance policy �'n tle name Mofe Town of Sou h Windsor:
7/
Date
Connection Charge Paid ' ��` Pe:inee�ing\Department
Fee: Paid $ ,=c�>•�-' C�;
C er Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date