HomeMy WebLinkAboutDrain Layers Permit 1310 Sunfield Drive TOWN OF SOUTH W1NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X? 4038
Pursuant to written application, permission is hereby ant d t t e Licensed Drain Layer
named herein to .perfo the wo k ind'cated elow at t .
at premises owned`by U � - 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
Desired Start ing =Date - Estimated Time for Completion.
Permit_ to 16 issued to
the holder of Drain"Layer's'Vicense No. Permit will expire thirty- (-N) days
after date of issuance. The undersigned DraFn Layerhereby 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 ar valid license issued by the State`of Connecticut and
has filed a satisfactory bond a4'4 insurance. policy in the name of 'the T wn of .So%itt Windsor:
Engineering Department , Date
Connection Charge Paid " Permit Fee: Paid $ .L , 60
Check Numbers i
Issued by
Tax D f ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions,-
APPROVED:
Inspector pate