HomeMy WebLinkAboutDrain Layers Permit 99 Scantic Meadow Ro TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT 55
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work, indicated below at Jc� SCa��'C Ah 4 j6 tu/
at premises owned by F'60 r n,-e r' whose address is
`rc S,7177 1Y1.e o w and to
Lay Ho se Drain, Repair House Drain, Lay Main, Other ,
for e,-s,l ,: �.�, T — occupancy or_use, with
Family Units., with acres.
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Type of Sewage to be connected under this permit: SANITARY SEWAGE -(to�r, INDUSTRIAL
WASTES ( ),n( OR ( ) S Stoft t QCMA,,6,K A— S to� Connection will be made with
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Show sketch of proposed work or furnish two (2) copies of separate dra ' gs.
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SPECIAL CONDITIONS 0 0
Desired Starting Date (- E timated Time for Completion / I)e c
Permit to be issued to
the holder of Drain Layer's License No. o Sl(,3� . 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.
Signed
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:
Engineering Department ate
Connection Charge Paid "`t' �� Permit Fee: Paid $
—40 Check Number -4* j 5U
f --1-1 A CAD
Issued by
Tax Office
INSPECTION `
Date work started Date completed
Sufficient notification received: tZ Yes No
Special Conditions
APPROVED: t 91)
Inspector pate