HomeMy WebLinkAboutDrain Layers Permit 77 Pheasant Way TOWN OF SOUTH WI N DSOR
M A .
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT5 ®19
Pursuant to written application, ermission is hereby granted to the Licensed Drain Layer
named herein to perform .the work indicated below at v ' ;� . s��`;; . ,,�)•U
at premises owned by J .( : who' a 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 thi permit: SANITARY SEWAGE (INDUSTRIAL
WASTES ( ), OR Connection will be made with
Show sketch of proposed work or furnish two O copies of separate drawings.
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r
460,
�rJo771,v-G 6 `��IAC e '
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Comp etion'.
Permit to be issued to k
the holder of Drain Layer's License No. Permit will expiq 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. A licant has receiv d
Town Permit No. , and/or CHD Permit No.
Signed {
nsed D -ain I,
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 thename of the Town of South Windsor:
''Engineering Department Date
Connection Charge Paid r"- ;;:i Permit Fee: Paid $
Check Number
i r Issued by
.Tax Office
Adak
SPECTION ' Q
Date work started Date,=completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspect r Date