HomeMy WebLinkAboutDrain Layers Permit 1204 Sunfield Drive TOWN OF SOUTH WINDSO`R
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Mo 3972E
, 192:
Pursuant to written application, permission is ljereby gr nted to the Licensed Drain Layer
named herein to perfo thewp�k- indicat�. below a Q
at premises owned by ,"a /-,( f}d tT�`�D�,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 SEWACE ( ), INDUSTRIAL
WASTES ( ), OR-- ( ) Connection will be made.with
Show sketch of proposed work- or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Startin"abe ---- - - — -- -=- ----Estimat-ed-Time-for-Compiet-ion -
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, Dxain 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, Sout' Windsor:
Englupeering Department -pate
Connection Charge Paid/cp-q_eT 4<�r7�� Pe it Fee:fi Pa` 4� 00
Check Number
Issued by
Tax' Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date