HomeMy WebLinkAboutDrain Layers Permit 1300 TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a 4-931-
19�
Pursuant to written application, permission is hereby granted to t Licensed Drain Layer
named herein to perform the work in icate below at :: .
at premises owned by e-Cr whose-raddress is
and toy,.
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 O,` 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 Estimated Time for Completion
Permit- to be issued-:to 'the holder of Drain. Layer's �License'No. Perinit" will expire 'thirty '('30)'`days
after date of issuance. The undersigned Drain Layer 'hereby agrees to all the teiis and
conditions set forth in the permit and the reverse side thereof. Applicant h as' received
Town Permit No, and/or CHD Permit No.
Signed
Licensed Drain Layer'.
The above named Drain Lay "has a' valid license issued by the State''of'Coi}nectcut and
has filed a satisfactory bong and insurance policy: n the name d`-the To of Souih Windsor:
Engineering Department Date
Connection Charge Paid -Permit Fee!' Paid-$ / a U
Check Number
Issued by
1 ) Tax Ciffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date