HomeMy WebLinkAboutDrain Layers Permit 47 Rimfield Drive a
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
O�c� DRAIN LAYER'S PERMIT 5 6 7
19
Pursuant to written application, permission is hereby granted tq the -icensed rain Layer
named herein to perform the work indi ated below at �1-
at premises owned by - yi7 � G�9 7` -
- -'. . 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.i /z
Show sketch of proposed work or furnish two (2) copies of separate drawings.
A S o; Ol rAf z,
SPECIAL CONDITIONS
Desired Starting Date,% Estimated Time for Completion off.
Permit to be issued to
the holder of Drain. Layer's License No. Z.az; /S 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 andthe reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed .
Licensed Drain Layer
The above named Drain Layer has a valid license iss ed by the State of Connecticut and
has filed a satisfactory bond and insurance policy i t name a Town of Sout Windsor:
ng neer�n epartment Date
Connection Charge Paid + 41 � Permit Fee: Paid $
eck Pumber
Issued by Ji
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date