HomeMy WebLinkAboutDrain Layers Permit 73 Saddleback Drive TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Me, 4728
Pursuant to written application, permission is her b r nted t the Licensed Drain Layer
named herein to perform the work indicate c� belo at j , �`
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.
i
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to J�� '�Z e T.
the holder of Drain La er's License No. •a7 . . Permit will .expire thirty (30) days
after date of issuancey The undersigned Drain Layer a eby agrees to all the terms and
conditions set forth in the permit and the reverse s Je hereof. Applicant- as received
Town Permit No. and/or CHD Permit No. '
Signed
Licenseil Drain Layer
The above named Drain Layer has a valid lice a issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
ngineering Department Date
Connection Charge Paid v Permit Fee: Paid
Check Num
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: 412LA6
nspector D to