HomeMy WebLinkAboutDrain Layers Permit 9 Podunk Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6042
l - ! 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named here n to perform the work indicated below at
oalk— c at remises owned bygQ(r / ( Co�1
whose address i T-` and to
Lay House Drain, Repair on Drain, Lay Main, Other ,
for S1--IQ L( 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 ( t/t
a Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
b�
SHA REQUIREMENTS MUS B FOhLOWE
SPECI L rNDI INS
a
Desired .Starting Date —lC�-- 9'`i Estimated Time for Completion r;
Permit to be issued to U )pc4a., (� ( I ��, 9s Wit► w
the holder of Drain Layer's L' cense No.� 2G 5 C,. Perms 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 0,tek --,
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the . State of
Connecticut and has filed a satisfactoryr
d and insurance policy in the
name of the Town of South Windsor:
/ n n ng Dept. Date
j
Permit Fee Paid $ k ,00 Check umber
Connection- Charge Receipt No. A'AC) Dated
Issued by
INSPECTION 1
Date work started Date completed /�/ ► /�—�
Sufficient notif icatjLo-- fece vea`; ryes No
Special Conditions
- APPRO
Inspector Date