HomeMy WebLinkAboutDrain Layers Permit 55 Cheshire Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT _ 3697
7
Pursuant to written application, permission is hgreb�Y ra ,e/d t the L ensed Drain Layer
named herein to :perform the work indicated below at LQ T it�.l.Q
at premises owned by —�! _ - :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 (L),, 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 Estimar Time for Completion
Permit to be issued to AA
the holder of Drain Layer's -License No. ermit' 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
used rain 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 tiie`Town of South Windsor:
2 Engineering Department -Date
Connection Charge Paid 3"� $�-4 2' Permit Fee: Paid $ (�b
Check _Nu er 6
-A 0 111 Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date