HomeMy WebLinkAboutDrain Layers Permit 525 Rye Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL cc
DRAIN LAYER'S PERMIT : :N O J 7
65
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Ayer named herein to perform the work indicated below t
at premises ,owned by Z21Q
whose address is and to
Lay House Drain, 'L,—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 bemade with 5 e�
Show 'sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date 41 Estimated Time for Completion
Permit to be issued to CwLC �
the holder of Drain Layer' s License No. Permit will expire thirty
(30) days 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.
S 3.-g-n e d _ _r
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
name of the Town of South Windsor:
Z.,
Engineering Dept. Date
Permit Fee Paid Check Number
Connection Charge Receipt No. Dated
Issued by e/ `/�/,�/
INSPECTION
Date work started 5'—)3— 9?- Date completed
Sufficient notification received : —'dyes No
pecial Conditions
APPROVED:
Inspector D tee
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