HomeMy WebLinkAboutDrain Layers Permit 24 Beechwood Lane TOWN OF SOUTH WI N DSOR
h` DEPARTMENT OF PUBLIC WORKS
l0 BUREAU OF POLLUTION CONTROL
5411
DRAIN LAYER'S PERMIT P,/'" "�®
19 C�C`
Pursuant to written application, permission is ere y granted to th Licensed Drain Layer
named herein to. perform he ork indi aced b low _� j�ec�lo
at premises owned by . Tpn whose address is
and to
Lay House Drain, Repair House sin, Lay Main, Other ,
--for occupancy or-,use, with
Family Units, with acres
Type of Sewage to be conn ted under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of propos 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 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 the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ 15 ,00
Check Number ,CjC�9
- 13-9v
Issued by
Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date