HomeMy WebLinkAboutDrain Layers Permit 30 South Satellite R TOWN OF SOUTH W1NOWK
3_ 7_ 9 S DEPARTMENT OF PUBLIC WORKS
4zL.--Afi 30, BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo, 4604
19
Pursuant to written application, permission is hereby grante to t e Licensed Drain Layer
named herein to perform the work indicated below at j1 Ls
at premises owned by ' ?-f J tT ui 04a whose address is
and to
Lay House Drain,
Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, with acres. I `Ay EX0,41-CHrb
Type of Sewage to be connected under this Permit: SANITARY SEWAGE ( ), I USTRIAL
WASTES ( ), OR ) Connection will b made with
n F �,c.p.!/p 00 10 Ana �YF y
Show sketch of propo d wor`k or ru ish (2) copies of separ to drawings. ` grr 1�10
I�SAv Prop �Q
L o ' ' ( �RG
7V TAP
t/ �x;s r SjMko{�iU� fl! T.FSPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.��2 3/�S 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 D in 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 namWthhe of South Windsor:
Engineering Department Date
Connection Charge Paid . Permit Fee: Paid $
Check Number t' 7�
I
I
_d}h�u L r2 -TL Issued by
I
Tax Office
INSPECTION
Date work started -2.- Date completed 2- —
Sufficient notification received: — es No
Special Conditions
APE
Inspector pate
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