HomeMy WebLinkAboutDrain Layers Permit 93 Rockledge Drive ti77 •r:—;iFF;__ay:: z-,1t^;•
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3620
03
Pursuant to written application,
pp permission is ereby ranted to the Licensed Drain Layer
named herein to. perfo the workn indicated below Jet S�11 A S
at premises' owned by ogj)d, t,D ntl,[R "t Cam, 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 Draiayer us License o P it ill eX ir. ,_ hix 0 ;da s.
�_ 14- .__�.P . gyp._ pY W Y _ -
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-
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the uame of the Town- of South Windsor:
Engineering Department Date
Connection Charge Paid#`Q- `� 9 Permit Fee: Paid $
Check Number
Issued by
Tax office
os �� s
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date