HomeMy WebLinkAboutDrain Layers Permit 259 Benedict Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5182 `
/(,//AZ, , 19 dc�
Pursuant to written application, permission is he e y g nted to icensed Drain Layer
named herein to perform the work ind ,cate. below at �( °' v,.� �>J
at premises owned by tic whose address is
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.
l /
1
SPECIAL CONDITIONS
Desired Starting Date timated 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
Licens d 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 i th ame of e T o South Windso
Engineering Departmen Da
Connection Char Paid �� `� Permit Fee: Paid
Check Number
Issued by
Tax Office"
a
INSPECTION
Date work started v Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate