HomeMy WebLinkAboutDrain Layers Permit 0604 Arthur Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT M_96
b - , 1 -
Pursuant to written application, permission is h r%by gr nted to t e Licensed Drain Layer
named herein to perform: the work indicated b low at - LI �--.
at premises owned by y- ' whose address is
and to
Lay House Drain, Repair Houser 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 O, 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`.t yer's -License No. Permit will expire "thirty (�O) -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
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 . n the name of. tIe`Town of South Windsor:
a -3
Engineering Department Date
Connection Charge Paid f Zt. � Permit Feet` Paid $ '
Check Number
�� � oil ` `-�✓ Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate