HomeMy WebLinkAboutDrain Layers Permit 350 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �, 4668
V U 19 .
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer
named herein to perforv} the wwork indicated below at
at premises owned by ray whose address 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 ( ) Connection 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 l � 7/�
the holder of Drain Layer's License No. 0 Permit will expire thirty (30) days
after date 'of- issuance. The undersignA 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.
Sided
•censed Ira-in.n '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:
Engineerin Department Date
Connection Charge Paid /_j�, ,(lt Permit Fee: Paid $
-- Check Number
j'd ,i,U Issued by
Tax Office
INSPECTION
Date work started 7 _ f - <'? Date completed
Sufficient notification received: v'Yes No
Special Conditions
APPROVED:
Inspec Date
it i/emo ronc a Cd 1STRUMON CO.
BUILDERS AND DEVELOPERS
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185 SILAS DEANE HIGHWAY WETHERSFIELD,CT.06109 PHONE: (203)563-3711