HomeMy WebLinkAboutDrain Layers Permit 1 Shadbush Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 531091
Pursuant to written application, permission is hereby gran ed to the is ed Dr .in La er
named herein to. perform the Fork indicated below at / y
at premises owned by -� a-!i, f �" (_a! �,4„,t 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 ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
F
i
t
SPECIAL CONDITIONS 101
Desired Starting Date E timated Time for Completion
Permit to be issued to {
the holder of Drain Layer's License o. rmit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees t "all the terms and
conditions set forth in the permit and the reverse side thereof. A pli ant has received
Town Permit No. and/or CHD Permit No.
Signed
Licende& Drain 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 intht-hhe� name of the To of South Windsor:
Engi Bring Depar " t Date
Connection Charge Paid ���'G''J L7 Permit Fee: Paid $
Check Number 41- J'
";'I 1,a c, l ��C {E '' Issued by
Tax Office
INSPECTION ` Q
Date work started Date completed
Sufficient notification received: es No _r
Special Conditions
AP R
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