HomeMy WebLinkAboutdrain layer permit 524 Sullivan Avenue N OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19 �
Pursuant to written application, permission is hereby g anted to the Licensed Drain Layer
named herein to. perform ..the work indicated below at � _. ,, (I(I(�,rg,� 1104 .
at premises owned by ;rti(.l��� �-f p < 1a. 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 furnish two (2) copies of separate drawings.
4
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to be issued to
the holder of Drain Layer's License o. Pe it will expire thirty QO) 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
M _�Ii�A A^S1T1r /ti�Q��.AA
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 th name of the wn of. South Windsor:
g neer g Department Da Ye
Connection Charge Paid f) y O O y Permit Fee: Paid $
- Check Nu er
Issued by
j Tax Office.
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date