HomeMy WebLinkAboutdrain layer permit 1372 Sullivan Avenue TOWN OF SOUTHI WI N DSOR
- DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o. 4414
/' , 191k6
Pursuant to written application, permission is hereb granted. to the Licensed Drain Layer
named herein to perform the, work indicated J�elow at �<
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 undet this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) a. Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimate-,; Time for Completion
Permit to be issued to ; �'� - i'j `��
the holder of Drain Layer's License No. ' Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Laye eby agrees to all the terms and
conditions set forth in the permit and the reverse ide hereof. Applicant ha r ed
Town Permit No. and/or CHD Permit No. 112
Signed lszz/� -
Licensed Dan Layer
The above named Drain Layer has a valid licens ssued by the State of Connecticut and
has filed a satisfactory bond and insurance policy nth -name of the Tom of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ i
Check Number /L% /
t Issued by
Tax Of f is e
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date