HomeMy WebLinkAboutDrain Layers Permit 672 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL A�
DRAIN LAYER'S PERMIT N�. 4927
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Pursuant to written application, permission is hereby graged to the Licensed Drain Layer
named herein to perform he work indicated below at Z 2111-16 cl
at premises owned by �C w CC.� L_ dt .�� whose dddress 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 ( ) Connecttion will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
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 La er 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. r
Signed :W G
Licensed Drain 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 in the name of the Town of South Windsor:
Engi Bering Depar ent Date
Connection Charge Paid �10 161q / 7 Permit Fee: Paid $ �%L/G 4
Check Number
Issued by
Tax Office
INSPECTION
Date work started ( Date completed /® 2--
Sufficient notification received: �- Yes No
Special Conditions
772
APPROVED
Inspector Date