HomeMy WebLinkAboutdrain layer permit 1559 Sullivan Avenue TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 2 124
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Pursuant to written application, permission is hereby granted to the-Li ce se rain Layer
named herein to perform the work indicated below at _-� i ,� . •
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.
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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 f rnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date -6 Estimated Time for Completion Ff
Permit to be issued to ,_� �li)XT (-61, T /�,,;/C,
the holder of Drain Layer's License No. Z , 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 �idj thereof. Applicant has. received
Town Permit No. and/or CHD Permit No. ( -----
Signed / l� L
Licence Drain L yer
The above named Drain Layer has a valid lice� issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid - / � 'u'�'- Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: G/Yes No
Special Conditions
APPROVED: Z.- R
Inspector pate