HomeMy WebLinkAboutDrain Layers Permit 599 Rye Street TOWN OF, ; SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ? 3752�
19v�
Pursuant to written application, permission is hereby anted o the Licensed Drain Layer
named herein to perform .t work indi to b low at ,
at premises owned:=by -- fita -. i¢ } �y c whose address is
Lay House Drain, Repair fIouse Dr'ain,` 'Lay Main, Otfe7r ,
for occupancy or ue 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 `` Es-timated Time for Completion.
Permit_ to be issued ,to
the holder of Draini Layer's h cause No "' Permit dill expire thi ffy� days_
-- =- ,:
after Sate o D� ra
f issuance. The undersxgne in'�Layer hereby agrees to a l,'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 WainLayei
The above named Drain Layer has a .va.lid; license"issued`_by the State' of"'Cori'necticut and
has filed a satisfactory bond and insurance policy in the name" of:'the„Town of '$outh-:Windsor:
- fEfigineering Department Date
Connection Charge Paid . �C Oo Permit-Yee: Paid
Check Number / �D
t )t t_ l7� ". Issued by"
Tax
INSPE ION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date