HomeMy WebLinkAboutDrain Layers Permit 1211 Sunfield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 3976
19 U,^_
Pursuant to written application, permission is he eb grarited. tp the Li ensed brain Layer
named herein to. perform he work indica ed be w at .
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 O, OR -O 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 Completionw .
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. Dra n 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 r .Date
Connection Charge Paid � ��j '�7� � Permit Fee Paid $ 2�J
Check Number ��11
Issued by
Tax of ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date