HomeMy WebLinkAboutDrain Layers Permit 1200 Sunfield Drive 7717, 77
TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , 3971
19
Pursuant to written application, permission is hereby g nted to thp, Licensed Drain Layer
named herein to perfo the w rk i dica d below at 1 Q
at premises- owned byD(,� SO�.L 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
i
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"tayer',s�.License No. Permit will expYre� thirty (30) days
after date of issuance. The undersigned Drain Layer hereby .agrees to all the teriris and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No anal/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 'hermit Fee: Paid $ D 0
Check Number a
�'� -,.• Issued by .
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date