HomeMy WebLinkAboutdrain layer permit 1330 Sullivan Avenue TOWN OF SOUTH WI N DSOR
/ DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the. Licensed Drain Layer
named herein to perform the work indicted below at^
at premises owned by r. .r y: �;_v.��i°;�,�� ` ;; f�� 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
1
Show sketch of proposed work or furnish two (2) copies of separate drawings.
,r•
t•.
SPECIAL CONDITIONS
Desired Starting Date Estimated T or ompletion
Permit to be issued to . r
the holder of Drain Layer's License No. ` Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer a eby agrees to all the termsnd
conditions set forth in the -permit and the reverse si a hereof. Applicant has ceived
Town Permit No. and/or CHD Permit No.
Signed
Licensed D, a n layer
—
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance polic ; n he name ,gf the To of South Windsor:
Engineering Department Date
Connection Charge Paid )i 'i, c_% Permit Fee: Paid $
Check Number / c -
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date