HomeMy WebLinkAboutDrain Layers Permit 1102 Sunfield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q 3992
19e�
Pursuant to written application, permission is hereby grant to ensed Drain Layer
named herein to perform:th ork in 'cated slow at (J�
at premises owned by
whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, witf`
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 �.-.� .
Desired Starting Date 1stimated- -time for Completion
Permit:to be issued 'to
the holder of Drain Layer's License No. . Permit will ex-0ire thirty (M)` 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. andjor 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 .Sout.h Windsor:
. : Engineering Department Date
Connection Charge Paid !/U "XIi i Permit Fee: Paid $
Check N
/ Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date