HomeMy WebLinkAboutDrain Layers Permit 23 Pleasant Valley R TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4879
Pursuant to written application, permission is bereby) granted to.t e L qenso ad .-Drain Layer
,*
named herein to perfor indicated
�L-the work below at
at premises owned by
who 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 , [�)avk
Desired Starting Date 1l Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. o J-S!?. 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
Liceilsed Drain Layer
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/ nameefthe Town of South Windsor:
4
-2ng'ln ering Departm!n bate
Connection Charge Paid(' j 17 Permit Fee: Paid
Check Number i
Issued by
Tax @ffi'ce
INSPECTION
Date work started
f7h_J Z r 7 Date completed
Sufficient notification teceived: Yes No
Special Conditions
APPROVED:
Inspector patd