HomeMy WebLinkAboutDrain Layers Permit E/S Rye Street TOWN OF SOUTH WINDSOR
DEPARTMENT .OF PUBLIC WORKS
BUREAU OFPOLLUTION CONTROL
DRAIN LAYER'S PERMIT N 38 9
$// Z , 19 S.S'
Pursuant to written application, permission is hereb gra ed tq the Licensed Drain Layer
named herein to. perform _the work indicated below at ,. . . . i
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.
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SPECIAL CONDITIONS
Desired Starting- Date. Estimated Time for Completion
Permit to be issued to.,
the holder of Drairi'Layer's ic2nse'No': Permit will ek- ire thirty (30) days
after date of issuance. The undersigned Drain 'LLayer hereby agree to' s thg - sand
-- - conditions set forth in the ermif 'and the reverse side thereof. plicant has received
Town Permit No. =and/or- :CHD .Permit No.
Signe. ,- '��w
Lie n� d Drain Layer
The above named. Drain,LA 'r has a' valid license iss ed b the 'State of Cohh-ecticut and
has filed a satisfactory bond and insurance policy, in the"riarge off the Town' of"°youth Windsor:
{
t
gineering Department i ;Date
Connect n arge Paid/ Permir,Fee: Paid
cCheck Number
Alt4j Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date