HomeMy WebLinkAboutDrain Layers Permit 36 Cheshire Drive TOWN Of SOUTH WI NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 37q8
Pursuant to written application, permission is hergb granted t, o �he Lic sed Drain Layer
named herein to.,perform the wok indicated below at �';z
at premises owned by ' 7` whose.address is
l7, and to
Lay House Brain, Repair `House Drain',.." 'Lay Main,` `Other' ,
for occupancy or use".1dith
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( , INDUSTRIAL
WASTES ( ), OR ( ) Co c on will be.made with
Show sketch of proposed work'or furnish two (2) copies of separate drawings:'
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Comphetion
Permit, to be issued to
the holder of Drain"Layer's -License No. Permit will expire thirty (3"0)-days
after date of issuance. The undersigned Drain Layer hereby agrees to alflthe terms �,and
conditions set forth in the permit and the reverse side thereof. Applicant has `received
Town Permit Na. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by .the State of Conner"ticut and
has filed a satisfactory bond and insurance policy in the name of the mown of,touth'Windsor:
Engineering Department -Date
Connection Charge Paid l U.d Permit Fee: Paid $ -�
Check Number 9�
Issued by
Tax of iue x
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date;,