HomeMy WebLinkAboutDrain Layers Permit 491 Buckland Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITQ
19�&
Pursuant to written application, permission is here y granted to th Licensed Drain Layer
named herein to. per£o:q . the work ndicat:e �.be ow:at.
at premises ofined. by c ,« ,
whose address is
Lay House Drain, _� Repair House Drain; and -to
for Lay'Main, Other
Family Units, with occupancy or use`, with
acres.
Type of Sewage to be connected u er th
WASTES p it: SANITARY SEWAGE ( , INDUSTRIAL
( ), OR ( ) - �� Connection will be made.-with
Show sketch of proposed work or furnish two (2) copies 'of separate drawing's.
SPECIAL CONDITIONS
Desired Starting`Date CEstimated Time f or-Completion
Permit_ to 'be issued t¢
the holder of Drain Layer'sTLic.ense No.
Permit' wil'1 expire :.- 1 {3p) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the ierms,'and
conditions set forth in the permit and the reverse side thereof. Applicant Iias received .
Town Permit No. and/or %CHD-Permit- No.
Signed
Licensed- Drain`t=Layer-
The above named Drain Layer has; a valid "Iiceiise; issued by the State of'•Connect`icut and
has filed a satisfactory bond and insurapce policy ,in the .name of the down of' South Windsor:
} Engineering Department Date
,.. :
Connection Charge Paid 'j1l�,aU Permit Fee: Paid
Check Nu ber 3
2u�_ _J
issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date