HomeMy WebLinkAboutDrain Layers Permit 121 Connecticut Aven TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 4392
19.
Pursuant to written application, permission is hereby granted to t Licen v!# Drain Layer
named herein to perform the wqr indic to below at
at premises owned by 2 �� kfn nrn 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 i. Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS r ,.
Desired Starting Data Esti ted ime for Com letion
Permit to be issued to (2ca
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 he ame of the To o South Windsor:
Engineering D art ent Date
Connection Charge Paid o6 o U Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date