HomeMy WebLinkAboutDrain Layers Permit 35 Shag Bark Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
t BUREAU OF POLLUTION CONTROL n
DRAIN LAYER'S PERMIT °''*'0 `�JO 3
c S Q ajL K 0 Ire� , 19 9,3
Pursuant to wri t n application, permission is hereb
y by granted to the
Licensed Dra,'n Lay r named herein to perfoarm. the work- indicated below a
= Zy � at pre s owned by /r_ ,
whose address is cf and to
Lay House Drain, A.�- Repair 'House D ain, ` Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INIYUS'TRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of prop se or furni wo (2) copies of separate drawings,
1
(' a
SPECIAL CONDITIONS 04��UI2tz-P"C?\JT& yYluST � �T
Desired .Starting Date Ti Estimated/ Time for Completion Z ley
Permit to be issued to ( T, / .
the holder of Drain Layer 's License No. 'Z_�ySZ-r- Permit will expire tfijrt,y
(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. a d/or
CHD Permit' No
Signed ._.... .-
L censed 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 Lin the
name of the Town of South Windsor:`
E in erring Dept. Date
. Permit Fee Paid $ 25 �o Check � ber
Connection Charge Receipt No. ��� Dated -\1-q�j
Issued. by Z
INSPECTION
Date work started f�- Date completed 2-- / 9 =..
Sufficient notification receive ,_ es No
Special Conditions
APP r
Inspector Date