HomeMy WebLinkAboutDrain Layers Permit 23 Beelzebub Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL 2
DRAIN LAYER'S PERMIT NNp, 4693
19&1;11
Pursuant to written application, permission is hereby ran ed t 7 Licensed Drain Layer
named herein to perform he work indi ted bel at
at premises owned by whose address is
IF and to
Lay House Drain, Repair House 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.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to 11da
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the holder of Drain Layer's License No. J O�o 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 �6vw•
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:
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En ineering Depart;Vent Date
Connection Charge Paid Permit Fee: Paid $
Check Number �p f
J,Cfr2- Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions „ t
APPROVED:
Inspector Date
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To help locate your, sewer, connection on-the main line where you would like the connection , please show
by drawing a line From the house or
the septic tank to the main line in the street.
so
stake in
to indicate line as shown on.sketch. IFyouu havelany,d ubtlplease ontacd
the Town Engineering- Department, t
Please draw important in Formation such as driveways, large trees
and other obstructions.
PLEASE MAIL THIS FORM IMMEDIATELY TO:
JAMES S. MINGES & ASSOC. , INC.
The Exchange
Farmington Avenue
Farmington, Connecticut. 06032
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