HomeMy WebLinkAboutWater connection to Ct. Water Company 73 TOWN OF SOUTH WI N DSOR
n DEPARTMENT OF PUBLIC WORKS
171'► BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 '
l :'
Pursuant to written application, permission is hereby granted to the Licensed Drain,La.yer
named herein to perform the work indicated below at
at premises owned by %,,; L;L)b �A whose address is
(,. f, Z (C and to
Lay House Drain, Repair House Drain, Lay Main, Other 1,
for occupancy or use, with
Family Units, with 2 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.
C_
SPECIAL C DITIONS
Desired Sta ing Date Z- =l Estimate EstimaterT Time for Completion ;e�
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 the.name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ 1
A Check Number ;° r .-.� )('L2
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification. received: Yes No
Special Conditions
APPROVED:
I c or Date