HomeMy WebLinkAboutDrain Layers Permit 630 Pleasant Valley 7-1
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TOWN OF. SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 91
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Pursuant to written application, permission is hereby anted to the Lice ed Drain Layer`
named herein to ;perfo he work i dicatzedt.b.elow at,:::.
at premises`own A - - -whose,-,address is
:and to: .....
Lay House ain, I�ep4ir .Houaa`'Diain : Zay Ma n
D"r , Ottie�r
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 furl sb two (2) copies 6i Separate drawin s
SPECIAL CONDITIONS
Desired Start ing`JDate Estimated Time'for..Completion ;a
Permit. to be issfr0d to _
the holder of Drain Layer Vic nse;N¢`. ; Permit wild expire `thirty (30)'ldays
after date of issuance. ' The'undo''rsigned "rain Layer'hereby agrees to a i the teems :and
conditions set forth in the permit and the reverse side thereof. Applicant as` received
Town Permit No. : _ > and/or:'CHD ,Permit, No.!,. .. _
a
Signed
Licensed:Drain Layer=�
The above named ArAin L�yep has a, valid' .license issued by` the" tpte Jof Connecticut and
has filed a satisfaeGpry bonc�,'ad .inaurarce, policy ,in tie a f ;the wn of,:South:Windsor:
Engineering :D.epar ent. -Date
Connection Charge Paid j"`` Perriziti Fee: Paid°
Check Number
Is!sued bq
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification tece ed: Yes No
Special Conditions
',PROVED
Inspector Date