HomeMy WebLinkAboutDrain Layers Permit Main Line Robins Woo TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
/ BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT _ 8
/ursuant to written application, permission is hereby ranted to the lAcensed Drain Layer
[ herein to perform t work indi fi, below at - K_9t2 /
premises owned by �- 1� whose address is
4 r -
and- to
dy House Dr >R'in, ` ep air- Hdus'e Drain, -Lay, Main, Otlier ,
-- .-
Eor occupancy .or-,use, with
jFamily Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (INDUSTRIAL
WASTES ( ), OR (. } Connect ,, will be made with
� ij
Show sketch of proposed work or furnish two (2') `copies of separate drawings.
GX���.c.a/LDY1
SPECIAL CONDITIONS
Desired Starting Date -Estimated- Tim for:::Completion
Permit- to be issued to
the holder_of --- L4gr;s ice a .� t 1 k !�, � ways _ _.-
after date of issuance. The undersigned Drainayer hereby agrees: to"ali' 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
Licensed' Drain Layer
The above named Drain Layer has a valid ;licen" issued by the 'Statle` of Connecticut and
has filed a satisfactory bond and insurance pol' y';in the name of th Town 'of South,Windsor:
Engineering..-Department Date
Connection Charge Paid 'Permit'`Pete: Paid-'$ ^ (90
Check Number
Issued by
`gin ,Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date