HomeMy WebLinkAboutDrain Layers Permit 111 Bourbon Street (2) TOWN OF. SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 7'
d 19 �S
Pursuant to written application, permission is her��y g nted to the icensed Drain Layer
named herein to perform the work ind3ebelow at //. �1� .
at premises- owned lliy Da'/,,� 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.
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' ali '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,biain 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:
En in g D.epartm t Date
Connection Ch rge Paid .�z b'S' Permit Fee: Paid
5 Check er % fc
G
issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
- --- -- APPROVED:
Inspector W Date