HomeMy WebLinkAboutdrain layer permit 00 Sullivan Avenue 1.
TOWN OF SOUTH WI N DSOR
o DEPARTMENT OF PUBLIC WORKS
II1� BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT v. 4710
19
Pursuant to written application, permission is her b grant o the cen ed Dra' Layer
4 named herein to perform the work indicated low a v \ a
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 furn' t ooft" p3 ""Qf rate drawin s.
t 40
SPECIAL CONDITIONS
Desired Starting Date , j` r Estimated Time for Completion
Permit to be issued to -,0v i rc� `>Tl`J G T'J u', 60 .
the holder of Drain Layer's License No Permit will a ire/th" ty (30) days
after date of issuance. The undersigne Drain Layer hereby agreesIt 111 he terms and
conditions set forth in the permit and the reverse side there A ici�i has received
-;Town Permit No. and/or CHD Permit No.
Signed ` i� :�
'sayer
j
The above named Drain Layer has a valid license issued by the Stt t-e"of/Connecticut and
has filed a satisfactory bond and insurance policy in the name of Ke Towif of South Windsor:
36
En ineering Depa ent 15ate
Connection Charge Paid 12' S Permit Fee: Paid $ /�� A
=--'J Check Numbigr- z-
' f Issued by
Tax Office
INSPECTION Q `�
Date work started 1 Date completed
Sufficient notification receive -. _ Yes No
Special Conditions
APPROVED:
Inspe for Date