HomeMy WebLinkAboutDrain Layers Permit 511 Spring Meadow Dr TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , 00 3770
4
19
Pursuant to written application, permission is reby granted to the Lice sed Drain LayerA
named herein to perfo the work l i�ndicated below at / a
at premises owned by hAj 0-P Dt-� 0' A&� n r hose address is
,'and t6i
Lay House Drain, Repair House `Dr'ain 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 1 ,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 i;ic,ense No: . Permit`Will -expire thirty (30)•,days
after date of issuance. The undersigned Drain Layer hereby ,agrees`ao 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 Conetticut and
has filed a satisfactory. bond and' insurance,po,licy in ,the name of the Towri of'So h`Windsor:
71 Engineering Department Date
Connection Charge Paid ��U. (}d a3 5 '-Perm .t Fee: Paid,$ Q d
Check mbe
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions-
APPROVED:
Inspector Date