HomeMy WebLinkAboutDrain Layers Permit 35 Alpine Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
Orr BUREAU. OF POLLUTION CONTROL ���� A
DRAIN LAYER'S PERMIT Nile. 4297
Pursuant to written application, permission is hereby granted to,`the Licensed Drain Layer
named herein to perfo-pm, the Tfork indica ed be ow at. 3 S' "' ; _iN i ; 4-, ;,,\ �` i:�,
at premises owned by , A;,t,. � 11 � 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 (e5, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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rPECIAL'CONDITIONS
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Desired Starting Date \ Estimated Time for Completion
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Permit to be issued to
the holder of Drain Layer's License No. Pe mit 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.
Signed
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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:
ngineering Department Date
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Connection Charge Paid .'�1 1d Permit Fee: Paid
Check Number ' )
Issued by
Tax Office
INSPECTION
Date work started Date completed'
Sufficient notification received: Yes No
Special Conditions IVNLWD
APPROVED:
Inspector Date
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