HomeMy WebLinkAboutDrain Layers Permit 10 Bramblebrae TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to.:perform -the work indicated below;at
at premises -owned by RSK whose address is
and to
Lay House Drain, Repair Douse Drain:, Lay Main, - Other
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected undey this permit: SANITARY SEWACE ( ), 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"Layers License No. . Permit--will expire thirty '(30) 'days
after date of issuance. The undersigned Drain Layer hereby agrees toI: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 theAiame of the' Town of South Windsor:
Engineering ep me t. Date
Connection Charge Paid •00 Permit Fee: Paid
Check Number -5j'2�
1
Issued by.,-Z�Z7 eze,91:1�
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
-- - - APPROVED:
Inspector pate