HomeMy WebLinkAboutDrain Layers Permit 124 Commerce Way TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT F;
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19
Pursuant to written application, permission is hereby gran, ed to the Lice sed Drain Layer
named herein to perform the work indicated below at�' Rj
at premises owned by
whose3address 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 ( ), 0 ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
3 `
SPECIAL CONDITIONS
Desired Starting Date - Estimated Time for Completion r
Permit to be issued to "—Z I
the holder of Drain Layer's License No. 67 7Y% Permit wi 1 expire thirty (30) days
after date of issuance. The undersigned Drain Layer Weby agrees to all the terms and
conditions set forth in the permit and the reverse sid' thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed e
' 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 �L'J G� Permit Fee: Paid $
Check Number (�
1
- LC2t,Le E ✓c Lc Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date