HomeMy WebLinkAbout6 PVC Street Cut Permits Lot 6 Jonathan TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT (VO 5738
19
Pursuant to written application,
PP , permission is hereby granted to the
Licensed Drain La er named herein to perform the work indicated below at
LOT y# i 6, J(ONAT�AIV LANE
r• r _ra :� at premises owned by t;7R C',QRUCTION
whose address is7ANC iEStfER, CCU --i yi. 99 E. CENTER STRE T and to
Lay House Drain, Repair House Drain, Lay Main, Other
for SI��GLE, FAMMLly.: ., 1_., 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 r . �= Estimated Time for Completion
Permit to be issued to
.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. r;�=;!`, and/or
CHD Permit No.
• Si ned
g ;
LicensedDrain 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 :
Engineering Dept. Date
Permit Fee Paid
Check Number ; v
Connection Charge Receipt No. Dated -
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Issued by,
INSPECTION
Date work started Date completed
Sufficient notification rece ve : es No
Special Conditions
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APPROVED:
Inspector Date
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