HomeMy WebLinkAboutDrain Layers Permit 169 Benedict Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo, 4498
L / ' 19
Pursuant to written application, permission is hereb granted to t1je Licensed Drain Layer
named herein to perform the work dl.'cate belo t
at premises owned by 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.
v
� 5
SPECIAL CONDITIONS
Desired Starting Date / /J — Estimated Time for Completion
Permit to be issued to �� (,C.P� � //V G
the holder of Drain Layer's Licens No. e 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
6-1 Licensed r
n 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 'n the name of the Town of South Windsor:
Engineering Deptment Date ar
Connection Charge Paid 'W®-(�� Permit Fee: Paid $Q�c
Check Number
r
� Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROV
ns ector Date