HomeMy WebLinkAboutDrain Layers Permit 36 Wedgewood -TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ,}
19a
t
Pursuant to writteft application, permission is hereby granted to the Licensed Drain Layer
named herein to perform t"he work indic ed below at .3(0 /,L)� � ,,; it�sc - ���
at premises owned by 4 _ i whose ad ress. is
C9 and to
Lay House Drain, Q 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 ()Q, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
ate.
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date ;t' - Estimated Time for Completion f _
Permit to be issued to AJ S j C. 7 %
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.
—T_
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Signed _ jr�i f%�,�
1/) LLiensed Drain Layer
The above named Drain Layer has a valid license issued `bp-the State of Connecticut and
has filed a satisfactory bond and insurance ,poliy in4the name f the Town of South Windsor:
r >
Engine g Department Date
_ U c
Connection Charge Paid P mit Fee: Paid $
�'Che�k Number
Issued by
Tax Office
l \ �
INSPECTION
ate work started `
Date completed 1 ,
Oufficient notification received: = Yes No
Special Conditions
- - APPROVED:
rfyJ% '
Inspector pate