HomeMy WebLinkAboutDrain Layers Permit 464 Quarry Brook Dri (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT +, O 5707
Pursuant to written a p iGation permission .is Hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
-,.- � ee r 1 at premises owned by �-
whose address is _ f � - ",,
/ " .I,` --( and to
Lay House Drain, Repair House ain, L y Ma!irf, Other
for 1' rtJ9 /., occupancy or use, with /
Family Urtits , with acres
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) OR ( )
Connection will be made with / "�°�/� P,se
Show sketch of proposed work or furnish two (2) copie opleparate drawings.
SPECIAL CONDITIONS
Desired Startin .Date 2
g Estimated Time for Gomplet-ion
Permit to be issued to l
the holder of Drain Layer's L tense No. 7(pg� Permit ` wi expire thirty
(30) days after date of issuance. The undersigned' ,D.rain 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
iF
L tensed Drain aver
The above named Dra3.n Layer has a valid license issued by the State .of
Connecticut and has fired a satisfactory bond and insurance .ipolicy in,. the
name of the Town of South Windsor;
0. ZA
n i eering Dept. Date
Permit Fee Paid Check tuber _
Connection Charge Receipt N,o, 4JI Dated
Issued by /f
.INSPECTION
Date work started �_ Z 9',� Date completed
Sufficient notification �ecei r'c7S"; r -yes No ----.r
Special Conditions
APPROV
Inspector Date