HomeMy WebLinkAboutDrain Layers Permit 54 Scantic Meadow Ro 13vie? SXe,-e/1
TOWN OF SOUTH WINDSOR 4-ee-9c)
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT n1 0 5432
3 19 7o
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at 541 -ScANTIc iy ),),gaCd j�-b
at premises owned by Po N�1-p A u L/N whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with /
Family Units, with L acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (vr. INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
1, b l� f 41L NTS
Show sketch of proposed work or furnish two (2) copies of separate drawings.
C- 0 "Z
SPECIAL CONDITIONS
Desired Starting Date t4MAIL :�6,/q90 Estimated Time for Completion /
Permit to be issued to CU!4,detcA rC AJ5?. �.
the holder of Drain Layer's License No. 207 2Z4 . 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.
Sig4ocf-
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 Date
Connection Charge Paid�'5��ccy-`E� Permit Fee: Paid $
-6 Check Number r. c h
Issued by
Tax Office
INSPECTION
Date work started Z6" o Date completed
Sufficient notification received: L/Yes No
Special Conditions
APPROVED: 'd
fff-spect—or Date
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