HomeMy WebLinkAboutDrain Layers Permit 1405 Arthur Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 965
A-(Y 195!r
Pursuant to written application, permission is he eb a ted t tie Licensed Drain Layer
named herein to ;perfo t e rk ted .b,elow; at �f4.-
at premises owned by d di whose-address is
and to
Lay House Drain, 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 ( ), OR ( )
Connection wil-1, 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 brain-Layer's'-License No: . '' Permit will expire thirty' (30) 'days
after date of issuance'. The undersigned. Drain Layer hereby agrees to all the-terns.'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 namedF,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:Soiith'Windsor:
z� -bti
n Engin ering Dep rtment Date
Connection Charge Paid / Permit Fee: Paid $ �
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date