HomeMy WebLinkAboutDrain Layers Permit Austin Circle (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
°l
D IN LAYER'S �;.1�1 0 5737
?,�- LA E S PERMIT
19
Pursuant to written. application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
/ l a t y L S`� 0 4
premises .owned b �/yf �" ('Gh
whose address is and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for ram- S occupancy or use, with S/✓I
Family Units '. with _acres.
Type ofSewage to be connected under this permit: SANITARY SEWAGE (1,
INDUSTRIAL WASTES ( ) , OR { )
Connection will be made with
Show sketch of proposed `wo'rk or furnish two (2) copies of separate drawings. .
SPECIAL CONDITIONS
1
Desired Startin Date g 6 Estimated .Timefor Completion
Permit to be issued o
the holder of Drain Layer's License. N j * Perr4it will: expire thirty
(30) days after .date of issuance,. T1W undersi.gned. Drain Layer hereby agrees
to all the terms andconditions set forth in the permit and the rever..se; .side
thereof. Applicant has received 'Town Permit No, and/or _
CHD Permit No. _
Signed
Li /in_ a ain Layer
The above named Drain Layer has a vali liceis ed by the State of
Connecticut and has filed- a satisfactory bond and urance policy in .the
name of the Town of South Windsor
� U�-9�
Engineering Dept. Date
Permit Fee Paid $ �/;Z �� Check Number
Connection Charge Receipt No. Dated
Issued by
ILNSPECTION
Date work started Date completed
Sufficient notification received: Y es No
Special Conditions
APPROVED:
Inspector Date