HomeMy WebLinkAboutDrain Layers Permit 219 Pleasant Valley MR
TOWN OF SOUTH WINDSOR ,
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT
Pursuant to written application, permission is hereby anted to th Licens x yei
Tamed herein to perform.the work. indi ed
lit premises owne ye d b ; ` w is
lay House Drein, Repair House' Diain; Lay Main,
for ---- r-r-- - occupancy o
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWACE,J ( , INDR
WASTES ( ), OR- ( ) + Connection w i; bewi
Show sketch of propo$ed work or furriish`tii+io `(2) cppies `of separate draw f s:
a. �d
t
t
Jt }I;3
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion,
Permit. to be issued to `
,r r.
the holder of Drain 'Layer's -License No Permif will expire , rty 3a)''d s °,
a' after date of issuance. The undersigned ' n er hereby agreesto ali '.the to m's a 4 11'�
conditions set forth in the permit and the reverse side there f p icant`has recei , 'd
E Town Permit No. and/or CHID Permit No.
Signed t;1 1c
�. - ,. L'cVtt
' ' a n Layer
The above named Drain Layer has a valid' 1'icense'issued by thee o Connee'ticut and
has filed a satisfactory bond and assurance poA i the ,name of the Town:of South',Windsor:
00,
O w�S
$ Engineering.:Department + Date
Connection Charge Paidz/j: ( Permit `l'ee: Paid $ 0O
Check Number-
s f/
Isued by
Tax Office
INSPECTION _
Date work started J Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: '
Inspector ptfe