HomeMy WebLinkAboutdrain layer permit 259 Sullivan Avenue Construction Inspection Report
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(2, TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19 k.:.,j.
Pursuant to written application, permission is hereby._granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by 1 e ,`" whose address is
..5 and to
Lay House Drain, Jµy 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 R), INDUSTRIAL
WASTES ( ), OR Connection will be made with
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Show sketch of pr sed work or furnish two (2) copies of separate drawings.
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1 �,
§�PECIAL CONDITIONS
Desired Starting Date Estimated Time for Completio
Permit to be issued to
the holder of Drain Layer's License Nc a Q 65 • -c; 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. l
Signed �ta�
Licensed Drain Layer
The above named Drain Layer has a valid lice a issued by the State of Connecticut and
has filed satisfa to bond and insuranc olicy� in the name ` f the Tow f South Windsor:
? E gine laid
g Dep# ent Date
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1.
onnection Charge Paid , (� rPer it Fe $
n Che4l Number
Issued .by _ cam` 4/(JZ// r
Tax Office
INSPECTION \,_
Date work started Date completed /4 `_
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date