HomeMy WebLinkAboutDrain Layers Permit 0602 Arthur Drive ,
TOWN OF SOUTM WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is he eby�gra ed to the Li nsed Drain Layer
named herein to :perform:the wor indica ed below at �- f f �,
at premises owned by GL-F
whose address is
Lay House Drain,: Repair House Drain, and to
for Lay Main, Other
Family Units, with ac res. occupancy or use, wit&'
Type of Sewage to be connected under this permit:WASTES OR SANITARY SEWAGE ( ), INDUSTRIAL
( ), ( )
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 thirt
after date of issuance. The undersigned Drain Layer hereby agrees: to all the terms ands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit. No.
Signed
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 Paid j��-3 ��- a 97 / Permit Fee: Paid $ >J , Q
J
Check Number"'
Issued by
LE Tax 0 f ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date