HomeMy WebLinkAboutDrain Layers Permit 566 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NN1,1o. 4934
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Pursuant to written application, permission is hereby granted to the Licensed' Drain Layer
named herein to perform_ the work indicated below at
at premises owned by +,,� ,..,.� _ ;1a�a- ,;'�' - :;);��� hose 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.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
-4,
Permit to be issued to _u 4-,SU
the holder of Drain Layer's License No. 619 Permit will expire thirty (30) days
after date of issuance. The undersigned rain Layer hereby agrees to all/ he terms and
conditions set forth in the permit and the reverse side thereof. Ap,•li ant has received
Town Permit No. and/or CHD Permit No.
Signed
.1 ( L ceased Drai Layer
The above named Drain Layer has a valid license issued by the St e 'Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid �r'; U•(�; Permit Fee: Paid $
Check Number
Issued by
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Tax Office L
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INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: O
Inspector Date
1