HomeMy WebLinkAboutDrain Layers Permit 80 Ident Road (3) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , 4861
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Pursuant to written application, permission is hereby granted to the �icensed Drain Layer
named herein to perform the work Ind t ic d
at below at
remises owned b
p y 7 i; 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.
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SPECIAL CONDITIONS
Desired Starting Date -/a sti d Tung for Completion
Permit to be issued to v (`vv
the holder of''Drain Layer's License No. 0 Permit will expire th' ty (30) days
after date of issuance. The undersigne Drain Layer hereby agrees to a he terms and
conditions set forth in the permit and the reverse side thereof. Appl c has received
Town Permit No. "> and/or CHD Permit No. Z)//
Signed
/
icensed ra n Layer
The above named Drain Layer has a valid license is , ed by the St f Connecticut and
has filed a satisfactory bond and insurance policy in the name of of South Windsor:
2�p
Engine ng Depar went Date
Connection Charge Paid .G c) Permit Fee: Paid $ / _ ) 0
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions _A�4 0K.,t
APPROVED:
Inspector Date