HomeMy WebLinkAboutDrain Layers Permit 49 Cheshire Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT O 308
Pursuant to written application, permission is hyerer gra t o t e Lice ed Drain Layer
named herein to perf-oTm 7enk d caged, below At �
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 (Klbe
NDUSTRIAL
WASTES ( ), OR { ) Connection wimade with
n /f
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 �c
the holder of Drain Layer's -Liceise 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. Applifca has received
Town Permit No. - and/or CHD Permit No. `
• w
Signed !
,Licensed 4Train Layer.
The above nameA -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 the Town`of'South Windsor:
Engineering Department; Date
Connection Charge Paid !j Permit Fee: Paid $ �,
Check umber a
Issued
"Tax ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date