HomeMy WebLinkAboutDrain Layers Permit 149 Brookfield Stree (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ® 3970
19 olff—
Pursuant to written application, permission is hereby anted. ta the LicApsed Drain Layer
named herein to perform
the worl& ind a below at AN
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.
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 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 the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid -1-/00.0 Permit Fee: Paid $ I�57.96
Check Number
/tiff - Issued by
B Tax Off is
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date