HomeMy WebLinkAboutDrain Layers Permit 12 Shadbush Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a,( 5 3 1 1
19
Pursuant to written application, permission is hereby granted to they Licensed. Drain Layer
named herein to perforF the. work indicated below at
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 O Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separa�le drawings.
x�
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to jl� 4711,�4_: �v. 2 RUC.
the holder of Drain Layer's License No. &t'* GbKh. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby a s to all the terms and
conditions set forth in the permit and the reverse side thereo Ap a.u.ict Yeas *reeived
Town Permit No. . and/or CHD Permit No.
Signe ,.y;�,__, w .
Lice d Drain Lay
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 To f South Windsor:
8c
Engin ring Depar !t D to
Connection Charge Paid � ' Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date