HomeMy WebLinkAboutDrain Layers Permit 100 Robert 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 hereby granted to th Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by „ c % %�,: j whose address is
A)4 and to
Lay House Drain, - Repair House Drain, Lay Main., Other ,
for / -- ( Z/-' - - i__ 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.
1 i
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion (/
Permit to be issued -to (� CJ� t�✓ ,ti
the holder, of Drain, Layer's Lic4se No. " U y"�j{ . Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all he terms and
conditions set forth in the permit and the reverse side thereof. A Inca t has received
Town Permit No. and/or CHD Permit No. . � / /J
Signed
/ ,/tice ed//brain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policx in he name the Town of South Windsor:
E gine . g Department Date
Connection Charge Paid er it Fee•.Mber
Paid $ � C)
1 j— J Ch s
Issued by
Tax Office
INSPECTION \.
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
LInspector Date