HomeMy WebLinkAboutDrain Layers Permit 60 Beechwood Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
�0 BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITS 5 Z 6
-- 4, / 191f
Pursuant to written application, permission is hereby granted to t e Licen ed Drain Layer
named herein to perform the,,work in below at � �
at premises owned by ��� , whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for 1'
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.
a> u-�
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion f
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 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.
SignedANr
\
Licensed Drai yer
The above named Drain Layer 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:
Engineering bepartment Date
r
Connection Charge Paid �/CrL S Permit Fee: Paid $ /�^ //O(y
Check Numbe-r-=''
A Issued by ,r
d ) 1
l./ Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
nsp c r Date