HomeMy WebLinkAboutDrain Layers Permit 110 Rugby Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT,OF PUBLIC WORKS
BUREAU,,OF POLLUTION CONTROL DRAIN LAYER'S PERMIT �,�'� NO 5 8 34
I bq- '
Pursuant to written Ipplication, permission is hereby granted to the
Licensed rain L. er named herein to perform the work indicated beLow a
l f at premises owned byr -
whose address is �6 , / 5 57` AVII?If C 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.
Gar/�
SPECIAL CONDITIONS
Desired Starting Date ip G Estimated Time for Completion
Permit to be issued to ST� � ,�C g v ,r� ��'5
the holder of Drain Layer ' s r; ficense No. 2G�k, .. Permit will expire thirty
(30) days after date .of issuance. The undersigned- Drain Layer hereby agrees
to all the terms 4nd cond tions .set forth in the permit and ,the reverse side
thereof. Applicant has a ivied Town Permit No. and/or
CHD Permit No.
Signed + 1. 5 ke
11L _1?�6
Licensed Drain Layer
1
The above named D ain Layer has a valid license issued by the State of
Connecticut and has f 1ed `a satisfactory bond and insurance policy in the
name of the Town o South Windsor:
Engineering Dept. 'Date
Permit Fee Paid, S Check- Number
Connection Ch a Receipt No. y2/S'� Dated Qf /U''J� r
Issued by
INSPECTION q
Date work started Date completed 2-0 •9Z
Sufficient notific—UT on received-; X— Tes No
Special Conditions
APPROV
Inspector Da e