HomeMy WebLinkAboutDrain Layers Permit 44 Bridle Wood Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 11O 4298
Pursuant to written application, permission is hereby granted_to the Licensed Drain Layer
named herein to perform the work indicated below at �s� �
at premises owned by ; l �16 `t v414 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 ( ) Conn c tio n w' 1 b PA4e with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date .-,EstimaAed Time for Compl tion
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
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 polio a name o ,the T of South Windsor:
C.
Engineering Depar ent W Date
Connection Charge Paid ��00 •C U Permit Fee: Paid $ / ) ,6u
Check Number
_ j 1
� r
IA Issued by
v
Tax Office
INSPECTION
Date work started Datelcompleted
Sufficient notification received: Yes o
Special Conditions
APPROVED:
Inspector Date