HomeMy WebLinkAboutDrain Layers Permit 1403 Arthur Drive TOWN OF SOUTM WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19{
Pursuant to written application, permission is ereby gra ed t the Licensed Drain Layer
named herein to ;perform he wLk i d cate�d below t �� � , . G
at premises oimed by �} T—T whose address is
and to
Lay House Dr in, Repair House Drain, 'Lay Main,
for Other
— -----
occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permits SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR { }
Connection will, be;made.with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
r
SPECIAL CONDITIONS
Desired Starting'Date. Estimated Time for Completion
Permit- to tie issued to
the holder of Drain Layer'6.1icense No. Permit 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 CID 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 satisfactoxy bond and insurance. policy in the name of the Town of South'Windsor:
.->- �3 _*5
Engineering Department Date
Connection Charge Paid ' �} �y Permit'Fee: Paid $
Check Number "
�'f/7 Uk� Issued by
r
�j Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date