HomeMy WebLinkAboutDrain Layers Permit 814 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 172
Pursuant to written application, permission is herAy ra to Veis s Dram ayer
named herein to perform the_. rk indicated below at �'/ t2�a " � ,
at remises owned b !' �G'r� '
P y �' - whose 96dress is
l/ 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 th'srpermit: SANITARY SEWAGE (�) INDUSTRIAL
WASTES ( ), OR ( ) `: `` ,; _i�:' Connection will be made with
f
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
t
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.,:: o _5 may. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain L yer 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 "
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 ift`the-,'6iame of the Town of South Windsor:
f �
Engineering Department Date
Connection Charge Paid . Permit Fee: Paid $ �j rr
'51 Check Number ` �c� 9/� /�f
�/ '•...�� -
j Issued by
® Tax Office �—
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date