HomeMy WebLinkAboutDrain Layers Permit Clark Street - main (2) TOWN . OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT3676
0
Pursuant to written application, permission is hereby granted to the L censed Drain Layer
named herein to. perform: the work i icated below at
at premises 40
-owned by ` ose' a Tess s
4tAl-, j and to
Lay House Drain,.. Repair House'Drain, 'Lay Main, Other ,
for occupancy of use, witl
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR O Connection will be made with
i
i
. 1
Show sketch of proposed work or furnish two (2)` oopies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for :Completion
Permit- to b2 issued to
the holder of Drain Zayer's -License No. Permit will, expire thirty (30)'=days
after date of issuance. The undersigned Drain Layer hereby agrees_ to 'all the terma'and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. - and/or CHID Permit No. ,
Signed
�Li ensed-Drain Layer
The above named Drain• Layer has a valid license issued by the 'S`tate`of Connecticut and
has filed a satisfactory bond and insurance policy in the name of t e down bf``9outl�`,.Windsor:
h. —1�7
Engineering De artment Date
Connection Charge Paid Permit Fee: Paid
Check Number
I`?;7,.�lCt �� L Issued b y,�
Tqx 4 ice ;
I�
INSPEC ION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date