HomeMy WebLinkAboutDrain Layers Permit 1104 Sunfield Drive 77
TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 990
19Cl l s
Pursuant to written application, permission is he by ranted to the Lic ns Drain Layer
named herein to. per£orm the ork indicated elow at
at premises owned- by whose:a dress 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 j
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 Estimated Time for Completion
Permit. to be issued to
the holder of Drain Layer's - icense 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 Drain Layer has a,valid license issued by the State of.`Coniiecticut and
has filed a satisfactory bond and insurance policy.'in the name of the Town of South Windsor:
Engineering Department Date
Connectio arge Paid l v �J Permit Fee: Paid $ J
Check Nu 2-
AA/ZJ Issued by
Tax office
.INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
< Inspector Date