HomeMy WebLinkAboutDrain Layers Permit 38 Rockledge Drive TOWN OF SOUTH WINDSDR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1
aw 142- 19 0Q)
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premise's owned by 'to2�, Lbw -� whose address is
t -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 O 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,o�;;Dram„Layar�;�Lc�n}�e_l�p.;,,�„" - exp3re�th�.r`
after date of issuance. The undersigned brain ayer hereby agrees .to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant las` received
Town Permit No. .: and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain, Layer has a valid license issued by the State, of Connecticut and
has filed a satisfac.tory.bond and insurance policy in the n�oftheown of South Windsor:
Engineering bepartment ll Date
Connection Charge Paid' 0 c) Permit Fee: Paid $ /� U
Check Number
Issued by '
s Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date