HomeMy WebLinkAboutDrain Layers Permit 90 Pine Tree Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N O 58 39
// c°/ 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
2- 1 f1,U1 -7 rcC� L q at premises owned by /176/n//4 77 M,' ?.7£S
whose address is V0 -/W efer 64 and to
Lay House Drain, ,�/ Repair House Drain, Lay Main, Other ,
for �j"r,i,'c c.t rwx4a )/ 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 1Z 5 �7 UC.,-
Show sketch of pr posed work or furnish two (2) copies of separate drawings .
SPECIAL C NDITIONS
Desired Starting Date 7 Zz lZ- Estimated Time for Completion Z ',�_
Permit to be issued to Tr7t'1 fPS
the holder of Drain Layer' s License No. )G '7,7-2 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 . T and/Qr
CHD Permit No .
Signed -
Lice sed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactorytbond and insurance policy in the
name of the Town of South Windsor :
E, gin . ing Dept . Date
Permit Fee Paid $ ."C) Chec0umber ( '�=
Connection Charge Receipt No . �1'3_( D ted
Issued by
INSPECTION 9
Date work started Date completed
Sufficient notification rece ve es No
Special Conditions
I
APPROVED: AMA
Inspector Date