HomeMy WebLinkAboutDrain Layers Permit 78 Rockledge Drive .._ma ._. z,.,r,...r. .�y;:*' ,s .,, �zl :...�,. �'i• —4:�:. - r'r+4#!'c _.: .4 '., '4' F —Y,'o'—�'*if ...:.
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
ILT
DRAIN LAYER'S PERMIT
fl g O Gk " c�� , 19
Pursuant to written application, permission is her be, y g rante(V to the Licensed Drain Layer
named herein to. perform he ork. in below at, �9
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_brain: L er s .neen e 1 -- Pemi?�W l .. pi.. eOZ
---
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 brain Layer has a valid license.'issued' by the State. of Connecticut and
has filed a satisfactory bond and insurance policy in the name of" the Town of South- Windsor:
Engineering Department Date
Connection Charge Paid D-00 Permit Fee: Paid- $
Check N be
i
ell
�Y1�ttck. Issued by
Tax f f ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes - No
Special Conditions
APPROVED:
Inspector Date