HomeMy WebLinkAboutDrain Layers Permit 39 Rimfield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is here�y grant- to t1e,Licensed Drain Layer
named herein to perform the work indicated below at �a J� M �( Ll A;a, w5
at premises owned b� 4i S whose 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 ( INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date L Estimated Time for Completion /Z, J 7 7
� 1
Permit to be issued to ^
the holder of Drain Layer's License No. 2.0 "yf L-.- Permit will expire thirty (30) days
Y
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 -;r l: '�' ,=�•. �fC`_
Licensed Drain Layer
The above named Drain Layer has a valid licen e i sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy�n he name o tlhe Town of South Windsor:
En Aiiie r k Department- Date
J
Connection Charge Paid ' Per t Fee: Paid $ ' >,
hec Number
Issued by
Tax Office
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INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
pec or