HomeMy WebLinkAboutDrain Layers Permit 199 Strong Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo. 5018
j yl 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work ind}cated ,below at f
at premises .owned by
b. whose address is
La House Drain and to
y /' Repair. House Drain, Lay Main, Other for �, r,bJ e.,,T�.jt,. , acres.
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Family � li -o �- occupancy or use, with
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Type of Sewage to be connected under this permit: SANITARY SEWAGE (14, INDUSTRIAL
WASTES ( ), OR ( ) All Connection will be made with
u�y e, .S�- .-ram m�>>J .���,.�,•
Show sketch of proposed work or furnish two (2) copies of separate drawings. G - 10 V C.
PC C-40 t�l
74
SPECIAL CONDITIONS
Desired Starting Date j�E'stimated Time for Completion _2— .�
Permit to be issued to �' �'- ; `6 / 0 ,
the holder of Drain Layer's License No.,:; d 90 . Permit will expire thirty (30) da s
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
�., nsed I) 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 name of the Town of South Windsor:
ngineering Department Date
Connection Charge Paid Permit Fee: Paid
` Check Number
_--� t Issued by
Tax Office
INSPECTION
Date work started 'Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector. --- --
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