HomeMy WebLinkAboutDrain Layers Permit 104 Rimfield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTIOWI:ONTROL p r�
DRAIN LAYER'S PERMIT 0 5 8 2 0
// 19 �
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er named, herein to perform the work indicated below t
�� 7�0 LI at p emises owned, b 0/?/1
whose a d d r e s s is (o s` Z � SO Sv✓' a n d _t.o---
Lay House Drain, . Repair Ho a Drain, Lay Main, Other ,
for N! i occupancy or use, with S j'y!C f?
Family Units , wiey acres,
hype of Sewage to be connected under this ,permit : SAN-ITARY SEWAGE ( ,
INDUSTRIAL WASTES ( J , OR ( ) :
Connection will be made with Sb k e7
Show sketch of proposed, work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS S H)q Re UI,4 /6
Desired Starting Date Z Estimated Time for Completion
Permit to be issue t 7-phl? �� v� S
the holder of Drain Layers License No.t=lyz?o 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 p/ - �J
.Lice ed ain Layer
The above named Drain Layer has a vali licen . issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid $ 1 `�F Check Number
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started -�Z '�!y Date completed
Sufficient notification receiveas es No
Special Conditions
APPROVED:
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Inspector Date