HomeMy WebLinkAboutDrain Layers Permit 1501 Arthur Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19&_.
Pursuant to written application, permission is hereby granted tote Licensed Drain Layer
named herein to perform .the wor. indicated .below at
at premises owned" by- - f .j i��mz �_
whose address is
La House Drain and to
3' , Repair'House' Drain, La ii
for Y Other' ,
occupancy or use, th
Family Units, with acres.
Type of Sewage to be connected under this permits SANITARY SEWAGE O, INDUSTRIAL
WASTES ( ), OR ( ) :Connection will: be made .with
i
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'thitty` {90)"-days
after date of issuance. The undersigned Drain ay,er hereby agrees to all ttt4 t1kft:.,and
conditions set forth in the permit and the reverse side thereof. Applicant ''a"s�received
Town Permit No.. . and/or-. CHD Permit. No.
Signed
- .. Licensed' Drain Layer
The above named brain Layer has a valid l"icens:e issued by. the State:of Connecticut and
has filed a satisfactot.-y bond. and insurance policy in the name of the To' " ofoiitly Windsor:
. _
Engineering epar:tment, Date
Connection Charge PaYdQ� eF6- *419 (�" permit Fee: Paid "
N
Check Number
Issued by
*A"Ta.
x affice
INSPECTION
Date work started Date completed
Sufficient notification received:. Yes No
Special Conditions
APPROVED:
Inspector pate