HomeMy WebLinkAboutdrain layer permit 1325 Sullivan Avenue TOWN OF SOUTH WI N DSOR
A DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 5299
Pursu nt to written pplication, permission is hereby granted to the Licensed Drain Layer
named herein to perfo the work indicated below at
at premises owned by.,(: p►�� (l)�%jj;m 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 J
WASTES ( ), OR ( ) Connection will be made with
LAM
Show sketch of p posed ork o furnish two (2) copies of separate drawings.
4,31
t /2 �
SPECIAL CONDITIONSA(-,,,IA
Desired Starting Date Estimate& Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. a?0 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
Licensed 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:
7 to /l9 -&2
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ 16-bb
Check Number
AhWM4�� a Issued by
Tax ffice
INSPECTION _ ( ,
Date work started Date completed 2� -
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
1