HomeMy WebLinkAboutDrain Layers Permit 1604 Arthur Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT B 0 '
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Pursuant to written application, permission is h�jreby ran ed o the 4censed Drain Layer
named herein to- perform he or indi ated below:at /�? -, , Y^
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, °Lay Main, Other
for occnparicy or use; with
Family Units, with acres.
Type of Sewage to be connected under this permitsSANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ) OR (' )
Connection will be. made with
Show sketch of proposed work .or furnish two (2) copies of separate d wings.
SPECIAL CONDITIONS
Desired Starting Date Estimated .Time for. Completion
Permit to be issued to
the holder of Drain Layer's -Liceftse No. Permit will expire thirty -(30') 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 has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain-Layer
The above named Drain Layer has a valid license issued by tie State of Connecticut and
has filed a satisfactory bond and insurance policy. in the name of the Town of South-;Windsor:
Z"L' `
Engineer ng Department Date
Connection Charge Paid q ®` C�`1 Permit Fee:` Paid$ 00
q , Check Number
1 U ' 6 Is'sued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED
Inspector Date