HomeMy WebLinkAboutDrain Layers Permit 10 Ravine Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
w�
DRAIN LAYER'S PERMIT4® '�
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform. the work indicated below at
a
at premises owned by -,� whose address is
A �r.;._; E.� u- �: :x i and to
Lay House Drain, t Repair House Drain, Lay Main, Other ,
for occupancy or use, with /
Family Units, with acres.
Type of Sewage to be konnected under this permit: SANITARY SEWAGE (X), INDUSTRIAL
WASTES ( ), OR ( ) «,r/��C Connection will be made with
If
Show sketch of proposed work or furnish two (2) copies of separate drawings.
or" i
TIi6
SPECIAL CONDITIONS
Desired Starting Date f , _,`h' Estimated Time for Completion j ,,i
3
Permit to be issued to
the holder of Drain Layer's License No. ,� 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.
f
Signed ,
Licensed Drain Layer
The above named Drain Layer has a valid lice. se issued by the State of Connecticut and
has filed a satisfactory bond and insurance poli ' in� the name f the Town of South Windsor:
E gine g Department Date
Connection Charge Paid Per�it Fee: Paid $ L`U
1
ec� Number �_)/b- _j
Issued by • ..1(�,_��'1.
Tax Office
1
INSPECTION Z
Date work started Date completed J
Sufficient notification received: Yes No
'_ecial Conditions
APPROVED: 3 g
Inspector p to