HomeMy WebLinkAboutDrain Layers Permit 103 Saddleback Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
.+ n/ BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4779
, 19 �
Pursuant to written application, permission is hereby/�rnt d to thg Licensed Drain Layer
named herein to perform the work indicated below at G' Yt ,
at premises owned by �.S R_ se 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to y - �
the holder of Drain Layer's License No." �_ . _- Permit wih expire thirty< (30) .:days
after date of issuance. The undersigned ra �er Eby agrees to all the terms and
conditions set forth in the permit and the reverse s de hereof. Applicant has 7���eceive
Town Permit No. and/or CHD Permit No.
y
Sig
ns Liceed Dr in Layer
The above named Drain Layer has a valid lice: issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Englr�edlrinktepartment Date
Connection Charge Paid ` l� !� Permit Fee: Paid $
Check Number 3 z�
Issued byj
Tax Office
INSPECTION
Date work started �-�� Date completed ( L/
Sufficient notification received: Yes No
Special Conditions 7j,�S2'/l/lG3
APPROVED: 3 — LF ^
Inspector Date