HomeMy WebLinkAboutDrain Layers Permit 11 Alpine Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X® 3
d/t/m-, / , 19 d,75
Pursuant to written application, permission is hereby rjanted to the Licensed Drain Layer
named herein to perform the work in icated below at / .
at premises owned by r6a 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.
•
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to be issued to
the holder of Drain Layer's -License No. 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. )
Si ed Cam• l�C/ LQw .
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 the name.of the Town of South Windsor:
Engineering Department Date
Connection Charge Paidd� Permit Fee: Paid $
Check Number p2
�,L Issued by
Tax of is
601
INSP9 CTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector ' __ Date
- t