HomeMy WebLinkAboutDrain Layers Permit 864 Strong Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
V
DRAIN LAYER'S PERMIT NO, 4855
Pursuant to writte application, permission is hereby granted to the, censed Drain Layer
named herein to perform the work indicated be w ��
at premises owned by 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 ( ) �r ,G. Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings. L�
o 60
�i � .� s'
!�SPECIAL CONDITIONS r�A/G
Desired Starting Date Estimated Time for Completion
Permit to be issued to r1 �'1 -.`� " r a ``.1 - k'. C .
the holder of Drain Layer's License No. 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
icensed Drain Oy4r
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond andinsurance poli�i�nhprname of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 77- X"
g Permit Fee: Paid )$ --
Check Number
Issued by
Tax Office
INSPECTION �`p
Date work started to completed
Sufficient notification received: Yes No _
Special Conditions
APPROVED•
Inspector Date