HomeMy WebLinkAboutDrain Layers Permit 1106 Sunfield Drive Al 117911—
TOWN OF SOUTH W[NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , ® 991
1 194fT ^
Pursuant to written application, permission is hereby gran d to the censed"Drain. Layer
named herein to.;perform th work indicated below at /Q
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 , R-
Desired Starting Date Estimated Time for Completion.
Permit_ to be issued to
the holder of Drain .Layer's License Na. ,`' ' Permit w 1 , e pire`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 ltaq a valid license issued by the S'tate% of Connecticut and
has filed a satisfactory bond and insurance policy in the name gf' the-'Town of 'go uth'Windsor:
Engineering Department -:Date
Connection ge Paid �� f Permit Fee: Paid $ �S LZ_� (�
Check Number
Issued by :gt�
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date