HomeMy WebLinkAboutDrain Layers Permit 480 Quarry Brook Dri TOWN OF T SOU H WINDSOR
U' V DEPARTMENT OF PUBLIC WORKS
�O BUREAU OF POLLUTION CONTROL p
V DRAIN LAYER'S PERMIT r.NO 5822
19 )Pt—
Pursuant to written application_, permission is hereby granted to the
Licensed Dxa.in Layer named herein to perform the work indicated below at
a�� os -e at premises owned by
whose address is ! v j, at Al ,. and to
D
Lay House Drain, Repair House ain, Lay Main, Other ,
for �✓ t®.�. oc.cupancy or use, with
Family U its, w' h acres.
Type of Sewage to be connected under thin permit : SANITARY SEWAGE
INDUSTRIAL WASTER ( ) , 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 oJC' (�cn- ,�� ,:.� ,
the holder of Drain Layer's Li ifense o, Permit ill `expire` th ' ty
(30) 'days after date of issuance* he undersigned Drain Layer hereby agr es
to all the terms and conditions set forth in the p-ermit_ and , the reverse side
thereof. Applicant has received Town Permit No .. and'/or
CHD Permit N'o.
Signed
censed Dra n Lay
The above named Drain Layer has a valid license issued by t e State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:'
E �indkering Dept. . Date
Permit Fee Paid $ o�_`j.Cj.Q Check Ndtber Cft3#4
Connection Charge Receipt No. R`5 Dated 2y-9 F
Issued by-; 2e, --`'
INSPECTION
Date work started ?-- Date completed 9'i
Sufficient notificarlon receive a: yes No
Special Conditions
APPROVED:
InsIfector Date