HomeMy WebLinkAboutDrain Layers Permit 41 Bridle Wood Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT off. 4299
19
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Pursuant to written application, permission is he. Feby grant d`to the Licensed Drain Layer
named herein to perform, the work indicated belo/W at �''�/' �; ,�,f��_�•,��y_�.J ��{�
at premises owned by (,1/� ��Q2y ,` . (.,? -it.;,�: ' 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 ( ) C nnecti n ill be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Yptimate4 Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit ill expire thirty (30) days
after date of issuance. The undersigned rain 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
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 pol' he name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid "/C'() 6 Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate