HomeMy WebLinkAboutDrain Layers Permit 646 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo. 5004
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Pursuant to written application, permission is herrgby ranted to th Licens ain Layer
named herein to perform t wor 'nd cated elo at Q-- l�fl�llrl
at premises owned by
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
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 CONDITIONSolill
•
Desired Starting Date ����Es�ima �edTi for mpletion
Permit to be issued to
the holder of Drain Layer's License No. "— 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 A W2 "`�
Licensed Drain Layer
The above named Drain Layer has a valid license issued by State of Connecticut and
has filed a satisfactory bond and insurance policy in the of t Town o South Windsor:
���3 /I/�?-cf-/
Engineering epartment .Date
Connection Charge Paid y��_Q� Permit Fee: Paid $
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Check Number
4 Issued by
Tax Office
INSPECTION
Date work started — Date completed
Sufficient notification received: eS No
Special Conditions
APPROVED: n
nsp ctor