HomeMy WebLinkAboutDrain Layers Permit 479 Quarry Brook Dri / TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT;2 5534
tc 1
Pursuant to written applic'd'tion, permission is hereby granted to the Licensed Dr
named herein to perform the work indicated below at �"; �`^� � Drain Layer
at premises owned b \ 6 ),)o
y - G Ct_ L`)�r� U hose address is
and to
Lay House Drain, -'` Repair ouse/Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
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 sepa ate drawings.
SPECIAL CONDITIONS
Desired Starting Date I - ` - 1 Estimated Time for Completion 2. Uv,u
Permit to be issued to f.,,� L'ilt2 1'� -,� 1 ✓�.HS
the holder of Drain Layer's License No. , _i; _f u Permit 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.
Signedf)—- (
_w
Licensed rain 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:
Engineering Department Date
Connection Charge Paid +�
Permit Fee: Paid $ /��
Check—Namhe ---��,
Issued by
Tax Office
INSPECTION
Date work started Date completed ( ^ �
Sufficient notification received: Yes No —�
Special Conditions
APPROVED: _
Inspector pate