HomeMy WebLinkAboutDrain Layers Permit 449 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q: 5069
Pursuant to written application, perrAssion is hereby granted to the Licensed Drain La yer
named herein to perform the work indicated below at ; � �w, b f, �f` - ✓
at premises owned by �=�b � -�-� ���
r ���r'" whose address is
House Drain and to
Lay , 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
f-
Show sketch of proposed work or furnish two (2) copies of separate drawings.
z
SPECIAL CONDITIONS
Desired St rting.Date Estimated Time for Completion
Viirmit to be issued to /A/i / ,L
the holder of Drain Layer's Li ease No. bA herml--
C� J . Permit will expir& 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
J �icen�sAdDra�ind�yer
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:
8c�
Engineering Department to
Connection Charge Paid YDd Permit Fee: Paid
Check Number
A— Issued by
Tax Office
INSPECTION
Date work started y1` Date completed
C._
Sufficient notification rec ived: Yes No
Special Conditions
APPROVED: Inspect r laate�E