HomeMy WebLinkAboutDrain Layers Permit 1304 Sunfield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4933
19�
Pursuant to written application, permission is tLqre . inted to the Licensed Drain Layer
named .herein to perfo the wok ind catedAbelowlat
at premises owned by = whose address is
-and:to
La House Drain` Repain`$ouse `Drain hay Main, `
y � Other ,
for occupancy 'or use, with
Family Units, with acres:
Type of Sewage to be connected under this permit: SANITARY SEWACE ( ), 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 isstied.,toff:
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. tfie` taimt—and
conditions set forth in the permit and the reverse side thereof. Applicant has`"r"eceived
Town Permit No.:,:} and/or-:CHO 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_ oufl Windsor:
Engineering epartment Date
Connection Charge Paid , ti t�j J�b,E�j Permit Fee: Paid $
Check Number raj I
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date