HomeMy WebLinkAboutDrain Layers Permit 1401 Arthur Drive TOWN OF SOUTH Wt N:DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT aQ
19(e
Pursuant to written application, permission is hereb anted to the Licensed Drain Layer
named herein to. perfom th rk indic t:ed below:at
at premises-,owned by V whose address is
La House Drain and to
y 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 O, OR O 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 Brain— yer 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 Dram 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 Char a Paid' !�` -( '19 Permit Fee:ee: Paid $
Q J
O
Check Number
Issued by
Tax affice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date