HomeMy WebLinkAboutDrain Layers Permit 1505 Arthur Drive TOWN OF SOUTH WI N`DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3 Q Q 4
- , 192�
Pursuant to written application, permission is hereby granted to the Licens d Drain Layer
named herein to .perform .the or.. indi aged b ow at ,.
at premises owned',by J /h- lln i� r'
Whose.-a;ddress is
La House Drain and to
y 'Repair"'House Drain, Lay Main, Other
occupancy or use With-,
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR O Connection will bemade-with
Show sketch of proposed .work or furnish two (2) 'c6pies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time.for-Completion :N
Permit. to .be issued `to`
the holder of Drain Layer cense No. . " _` ' Permit will expire thirty (30), days
after date of issuance. The undersigned Drain Layer hereby agrees to all the"tertns' 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 Draiw Layer
The above named Drain Layer has "a valid license issued by'the 'Sta6i of Connecticut and
has filed a satisfactory bond and insurance policy, in then the Town of South`Windsor:
Engineering.Departm t Date
Connection Charge Paido� Permit 'Feet Paid $
Check Number 161(o _
Issued by
Tax of ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date