HomeMy WebLinkAboutDrain Layers Permit Carriage Drive - Mai TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 367
Pursuant to written application, permission is h reby grant to the Licensed Drain Layer
named herein to. perform the work indicated below at
at premises owned by bd L j I ) i / t S- P-D Al .whose. address is
�T and to.
Lay House Drain, Repair House Drain, Lay Main, 'Other ,
for occupancy or use, wilt,'
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (4-."-I NDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furbish two (2) copies of separate drawings.
§PEJC At, ,DONDITIONS
Desired St4j.t. g -Date Estimated Time for Completion .-
Permit- to be issued to �
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 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 grain Layer has a valid license issued by the State of Coninecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of. South Windsor:
:Engineering Department. ..Date
Connection Charge Paid Permit Fee: Paid $
Check Number
�1 ;r. " Issued by
Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date