HomeMy WebLinkAboutDrain Layers Permit 92 Troy Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WRVS
11/ BUREAU OF POLLUTION CONTROL
h�VDRAIN LAYER'S PERMIT 1We. 4374
Pursuant to written epplleflCion, paamiaeion Ss fie b gsafifiFed t0 a Llceneedd Drain Layer
named herein to perform Ch ' k dice below ae /
at promisee owned by U whose address is
and to
Lay House Drain, Repair House Drain, Lay gain. Other
for occupancy or use, with
Family ULiCS. With acres.
Type of Sewage Co be connected under this permit SANITARY SEWAGE O. INDUSTRIAL
WASTES ( ) , OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of Separate drawings.
f
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Peralt vill 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 r side thereof. Applicant has received
Town Permit No. and/or CHD Permit No. ((��
Signed
Licensee Drain Layer
The above named Drain Layer has a valid Itcl Ise issued by the State of Connecticut and
has filed a satisfactory bond and Insurance policy In bhA-sake of the Tope of South Windsor:
EngSneeriug Department Dale
Connection, Marge Paid " LSa Permit Fee: Paid $ /S, J�yG
Check Number
Ji4a� � �/ " ' :"'� Issued by ��lla.cN / ' �✓ M-•—�
Tax Office /
INSPECTION
Date work started Date completed
Sufficient notification received: Yes _ No
Special Conditions
APPROVED:
Inspector Date