HomeMy WebLinkAboutDrain Layers Permit 33 Cheshire Drive TOWN OF SOUTH Wl N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q L
19 <� S
Pursuant to written application, permission is herebyanted t the Liceled Drain Layer
named herein to.-Perform the work indicat: abelow at � .., +33
at premises ownied. by whose :a'ddress is
and to.7:;
Lay House Drain, ': Repair ��Hu ose'`Drain, -Lay =s 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 Start ,ng"Date Estimated. Time for G.omplet ion. .
Permit- to be issued ;to
the holder of Drai :'L er's License: No. Permip will expire thirty (S0)� days
after date of issuance. The undersigned Drain Layer hereby agrees' o all the"ters .and
conditions set forth in the permit and the reverse side thereof. Applicant tias received
Town Permit Noi and/or CHD :Permit No.
Signed
Licensed Drain Layer
The above named brain,Layer has 'a, valid'.license issued" by the 'State' of''Connecticut and
has filed a satisfactory bond- and insurance policy,. n ,t e 'name of�'he Tawas of South Windsor:
Engineering Department; ;Date
Connection Charge Paid l d 'Permit Fees Pahl $
Check Number Z-
Issued by
Tax dffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date