HomeMy WebLinkAboutDrain Layers Permit 84 Chatham Lane TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ? 3688
19Py--
Pursuant to written application, permission is hereb r ted/ o t e Licen ed Drain Layer
named herein to perform. he work indicated.below at - [ �tn'l
at premises dwned by whose address is
F 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: SAANITARY SEWAGE ( ), INDUSTRIAL
WASTES O, OR O Connection will be made with
Show sketch of proposed'_work` or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Startiiig'Date Estimated Time for Completion:
Permit to 'be issued to
the holder of Drain,;Layer's �License No. Peritit' w 11 expire thirty (30) -days
after date of issuance. The undersigned Drain Layer hereby agrees to all 'the tekis 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 licens-e issued by the State of Connecticut and
has filed a satisfactory bond and insurance., policy. n the name of the T wn of Soutt `Windsor:
.Engineering Depar ent Date
Connection Charge Permit Fee: Paid '$
A Check Number 17 —
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date