HomeMy WebLinkAboutDrain Layers Permit 119 Scott Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT _ j S 6
Pursuant to written application, permission is hereby granted o._,the Licensed Drain Layer
named herein to perform the w rk in t d below at .1 j cca � ,
at premises owned by °�1y�Pu 'tir. ctv, whose address is
<->rn and to
Lay House, Drain, �/ _ Repair House Drain, Lay Main, Other
for C , U- T tAaS
occupancy or use, with �—
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ), INDUSTRIAL
WASTES O, OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS 1�11)/Y(2
Desired Starting Date Estimated Time for Completion
Permit to be issued to R )h /�1� _ a iy/�Gt�s ei
the holder of Drain Layer's License No. ;U 5"5 y. Permit will expire thirty (30) days
Y
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.
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 poli y in the name f the Town of South Windsor:
n Department Date
Connection Charge Paid � ' PieJmEngineEfr'
it Fee: Paid $
C. e' iec Number cJ
Issued by _ r— -
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date