HomeMy WebLinkAboutDrain Layers Permit 89 Saddleback Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4890
f 196
39 ad&zba-K
Pursuant to written application, permission is ere y grant to the Licensed Drain Layer
named herein to perform;the work indi,ated blow at
at premises owned by cj � _.J ,�_ ( 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.
SPECIAL CONDITIONS
Desired Starting Date —4 Estimated Time for Completion
Permit to be issued tom � .
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer he by agrees to all the terms and
conditions set forth in the permit and the reverse side hereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signedy_
Licensed Drain Layer
i
The above named Drain Layer has a-valid licend!�ssued by the State of Connecticut and
has filed a satisfactory bond and insurance polic n e name of the Town of South Windsor:
G �l vJ ._9 _
Engineering Department Date
Connection Charge Paid qyq e 7 B 5 l Permit Fee: Paid $
Check Number O`
}}, YY
�J { 1 (r Issued by
Tax a ice
l
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate