HomeMy WebLinkAboutDrain Layers Permit 541 Quarry Brook Dri TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
P
DRAIN LAYER'S PERMITfL
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Pursuant to written application, rmission is hereby granted to the Licensed Drain Layer
named herein to. perform the work indicated below at -7J ``
In-T �"�`'Q
at premises owned by � (� �, (; „ 4 ose 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 (✓f, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with.%
Show sketch of proposed work or furnish two (2) copies of separate drawings.
1
— --------- _
SPECIAL CONDITIONS
Desired Starting Date Estimated--Time for -Completion-
Permit to be issued to ,��,�. L_,J,,� 7,
the holder of Drain Layer's Licen e_�No. `•__2,,; 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.
Signed _ 9
�� .License rain Layer
The above named Drain Layer has a valid lice se i sued by the State of Connecticut and
has filed a satisfactory bond and insurance polic in he name he Town of South Windsor:
ngin e g Department Date
��/ c�/ �(
Connection Charge Paid P mit Fee: Paid $
Ch ck umber
Issued by
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Tax Office
INSPECTION
Date work started j` 29- \`Date completed
Sufficient notification received: No
Special Conditions
APPROVED:
Inspector Date