HomeMy WebLinkAboutDrain Layers Permit 1502 Arthur Drive TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
1
Pursuant to written application, permission is hirebY 'ranted to the Licensed Drain Layer
named herein to perform.< he wor indi a.ted.below::at a
at premises owned ,by whose address is
Lay and to >:
for House Drain, �T Repair House Drain, _'Lay Mains -Other ,
occupancy or use,te 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 issued to
the holder of Drain Layer's License No. :`` Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agieesto''a11 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 Draisi Layer
The above named. Drain Layer has. n va]id` license "issued ti"y;the State of'Connecticut and
has filed a satisfactory bond and insurance. polity. n the name of wn of $oufH;_Windsors
n
Engineering Department -Date
Connection Charge Paid Q�df� � � permit Fed: 'Paid PE E 00
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
sufficient notification received: Yes No
Special conditions
j
APPROVED:
Inspector Date