HomeMy WebLinkAboutDrain Layers Permit 11 Pine Knob Circle C/lJi S".}�•M. 'l. _-,ice• _I -
TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
/ BUREAU OF POLLUTION CONTROL
DRAIN LAYER`'S PERMIT 5882
C. 19
22=
Pursuant to written application, permission is hereby granted to the
Licensed Dra. n. Layer named herein to ,pe;rfo.rm the work i dim catedLbelow
\N at remises owned by �n 4 evr
whose 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 this permit : SANITARY SEWAGE ,
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 c, Estima ed Time for CompletionY401 4Z_
Permit to be issued to"
the holder of Drain Layer's License No. Permit will e41re thirty
(30) days after date -of issuance. The undersigned Drain La,yer .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
CG f 1 � v�/ , Signed
Licensed Drain Layer
The above named Drain-: Layer has a val d 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 Dept. Da.te
Permit Fee Paid $ p`Z j .� Check Number }J1
Connection Charge Receipt No. a Dated
Issued by
.
INSPECTION
Date work started ." 2--^ Date completedZ
Sufficient notificatlon r ce v es o '
Wit-�: - _ -- --
,.y .t
�-
APPROVE �f� /Z
Inspector Date