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HomeMy WebLinkAboutDrain Layers Permit Lot A2 Robins Wood TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL �T DRAIN LAYER'S PERMIT Rio. 4433 Pursuant to written application, permission is hereb g ante to, the Licensed Dr in Layer, named herein to. perfo he ork indicated below at e- C r r PA. 7,: i 1& _.` at premises owned by _ 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. SPECIAL CONDITIONS Desired Starting Date Estimated Time for Completion Permit to be issued to the holder of Drain Layer's License No. ��, r� Permit will expire. thirty_ {3Q)_ 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 LicenselADrain Layer The above named Drain Layer has a valid license issued by the St to of Connecticut and has filed a satisfactory bond and insurance policy I)a the name of theiTown? of South Windsor: Engineering Department Date Connection Charge Paid - 11/ O 4-�' � � Permit Fee: Paid $ � CJ Check Number Issued by Tax Gi f ice V INSPECTION 3, Date work started �D 2�r�v �� ✓� Date completed Sufficient notification received: Yes ✓ No Special Conditions?'ffG= W,y��/ /IrJs;r� L-� !/t° 7-z:' —,77i'�� Z6Oy.Sa— /✓G--APPROVED: zgZ2;�2 /©^ZZ 06' Inspector Date