HomeMy WebLinkAboutDrain Layers Permit 132 Quail Run TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT i?F-No 5790
/ 0 , 1912-
Pursuant Qo 'writt�n�aJp0pAic(a)tion, permission. is hereby granted to the
7 7"
Lice e rain Lay .r n meld herein o perform the work indicated below at
M4Ppre ises o ned y
whose add ss is f'o. {�j GY- and
to
Lay Hous � Dr in, Repair Ho se Drain, Lay Main, Othe ,
for / / occupancy or use, with
Family ni s, Vfth acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ) ,
INDUSTRIAL .WASTES ( ) , OR ( )
ConneQln will be made with
1
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS O S 4Q
Desired Starting Date Estimated Time or mpletion
Permit to be issu d o �"
the holder of Drain Layer ' s License No. Pe mit will expire thirty
(30) days after date of issuance. The undersigned Dr in ayer 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 ! �
Lice ed ain Layer
The above named Drain Layer has a valid licens is ued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of -the Town of South Windsor:
pp'' Engineering Dept. Date
Permit Fee Paid $ �� </S Check Number
Connection Charge Receipt No. H Z �j Dated U
Issued by
INSPECTION
Date work started ��� Z' Date completed
Sufficient notification rece ve : FN yes No
Special Conditions
APPROVED: A?L2 e, Z_
Inspector Date
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