HomeMy WebLinkAboutDrain Layers Permit 111 Cheshire Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT UP 3690
-S Lo i 19—L
Pursuant to written application, permission is hereby rant to the Licensed Drain Layer
named herein to.,perform the work indicated below at � i
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 ( ), 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 - Estimated Time for-Completion-.;.
Permit_ to be issued to _
the holder of Drain, Layer's -License No. Permit will 4_k_ re thirf� (:'O)' days
after date of issuance. The undersigned Drain Layer hereby agrees` to' all the' te 's 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 .Connecticut and
has filed a satisfactory bond and insurance, policy iri the r . of ;th, Town:'of `South Windsor:
Engineering Departm nt .- : Date
Connection Charge Permit-Feet Paid $ Z) a
Check Number
.� Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date