HomeMy WebLinkAboutDrain Layers Permit 17 Cheshire Drive TOWN OF SOUTH WI NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q3689 -
64� 19
Pursuant to written application, permission is her by gr me t�}e L 1�;ic sed Drain Layer
named herein to perform the work indicated .below. at . Zn} y-- -017
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, 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
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 in th me of tha own Of``$outh Windsor:
Engineering Dep tment Date
Connection Charge Paid y -�� (�l vim- Permit Fee: Paid $
Check Number
Issued by
Tax Ciffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date