HomeMy WebLinkAboutDrain Layers Permit 27 Arrowwood Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Mo. 4911
7
19 < l
Pursuant to written application, permission is tereby granted the/ Licensedi rain L,. yer
named herein to perfo the w rk indicated below atA � - C ,�/
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 ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to jp % h C
the holder of Drain Layer's fl-ceCnhe 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
Liven. 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 in the name of the Town of South Windsor:
Eng fffeering Department Date
Connection Charge Paid. �`�l � 7
g , ��, C � � -
Permit Fee: -Paid $
Cbeck Number
, .���� ��-+fi t •'Ij 2'1) .1 Issued by F
Tax Office I,
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date