HomeMy WebLinkAboutDrain Layers Permit 16 Stiles Court TOWN OF SOUTH W!N DSOR
't DEPARTMENT OF PUBLIC WORKS
\ BUREAU OF POLLUTION CONTROL
\ DRAIN LAYER'S PERMIT 5778
6711
19�
Pursuant to written application, permission is ereby granted to the
Licnens Dr i L y r named herein to perform the wok indicatedbelow at
I- 1 p 5-7 at premises owned by S 6rjSj�
whose dr-ess is S S-a,, and to.
Lay House Arai-, Repair use D ain, Lay Main, Other ,
for S/� Lo Muse
or use, with
Family Unit , with acres.
Type of Sewage o be connected under this .permit : SANITARY SEWAGE ( ) ,
INDUSTRIAL WASTES ( ) IOR ( )
Connection will be made .with ." if
Show sketch of proposed.;'work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date e012 Estimated Time. for Completion
Permit to be iss d to,
the holder of Drain Layer' s Oli6e Permit will expire thirty
(30) days after date of issuance. T e undersigned Drain Layer hereby agrees
to all the terms and conditions set forth in the per it nd the reverse. side
thereof. Applicant has received Town Permit No. and/or
CHD Permit No .
Signed
Li ens d D in Layer
The above named Drain Layer has a valid icense issued by the State of
Connecticut and has filed a satisfactory and and in urance policy in the
name of the Town of South Windsor: ///�
ng ne Dept. Date
Permit Fee Paid $ ZS w U Check N mber d 4 0
Connection Charge Receipt No. 4-1 7 D ted &
Issued by
INSPECTION
Date work started Date completed
Sufficient notification received: yes No
Special Conditions
APPRO4jo
Inspector Date