HomeMy WebLinkAboutDrain Layers Permit 1402 Arthur Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT -OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ? 3962
19 ,
Pursuant to written application, permission is hereby g=to h Licensed Drain Layer
named herein to perform the woFk ind cat.e A
below at _
at premises owned by ( : . . ..whose address is
and to
Lay House Drain, Repair Douse =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 issuer'to
the holder of Drain.Layer's -License No. Permit will expire thirty' (30)-"days
after date of issuance. The undersigned Drain Layer hereby .agre.es to all the 'ter" '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 in 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 Pa d lP- 4�o*19 /? Permit Fee: Paid`:$
Check Number
Issued by
Tax 10ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: -
Inspector Date