HomeMy WebLinkAboutDrain Layers Permit 159 Pine Knob Drive " TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3
JlaL 19 ;
Pursuant to written application, permission is hereby granted to the L'censed Drain Layer
named herein to perform the work indicated below at
at premises owned by , �' �-% '1 whose address is
, _ ' )/r , and to
Lay House Drain, Lam' 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. 'f 4P�C�
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SPECIAL CONDITIONS t-. ✓f1/ CE f � f/� �'
Desired Starting Date ( , -- j Estimated Time for Completion
Permit to be issued to � �;;�
the holder of Drain Layer's License No. ,� 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
i ensed brain layer
The above named Drain Layer has a valid license ssifed by the State of Connecticut and
has filed a satisfactory bond and insurance policy 1: th�) name of _-. -e�/1Town of South Windsor:
1
En ineer n epartment Date
Connection Charge Paid ��-'��1 1 Permit Fee: Paid $
t
;`Ch,.eck NuMier ,
Issued by G
Tax Office
INSPECTION q
Date work started ' 9 Date completed z1—
Sufficient notification received: Yes No '-
Special Conditions
APPROVED: C�
Inspector pate