HomeMy WebLinkAboutDrain Layers Permit 1504 Arthur Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19�
Pursuant to written application, permission is hereby granted to he Lcens d Drain Layer
named herein to perform a ork nd cated elow _at , f7 L� ` cen
at premises owned :by - ; :.whose address is
and to
Lay House Drain, Repair"Hous"e `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 Startin`g,Date Estimated-,Time for Completion
Permit_ to be issued to
the holder of Drain Layer's -License No. Permit will expTire° thirty �(10) 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 hag received
Town Permit No: and{or,CHD Permit No.
.Signed.
Licensed Drain Layer;
The above named Drain tay_er' 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:
2y- ti
Engineering Dephrtment, Date
Connection Charge Paid - Permit Feet Paid $ % C'
Check Number _ Q
Issued by
Tax Mfice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date