HomeMy WebLinkAboutDrain Layers Permit 190 Pleasant Valley (2) TOWN OF SOUTH WIN SOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNIo, 5029
Pursuant to written application, permission is hereby g ted to th icenSgd Drain sayer
named herein to perform the work in44cated bel9w at U d, V� i
at premises owned by NA iS - U, A whose" a ress 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 drawi gs.
�%0.5�£
01
J{GC,
V),
SPECIAL CONDITIONS J�
Desired Starting Date Estimated Time for Completion J "2 - -L z - d 7
Permit to be issued to C, l �,, , �. 1/ •e-- / AJ G
the holder of Drain Layer's License o. - a> l . 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 L
License rain 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�iintname of the Town of South Windsor:
r` lZ..-2-Z 47
Engineering Department Date
t
ter_ ,D
Connection Charge Paid ) —7 " `5"'A'> Permit Fee: Paid $ j J (�
Check Number a..
Issued by
Tax Office
INSPECTION
Date work started f'Z Z'2 — ( Dane completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate