HomeMy WebLinkAboutDrain Layers Permit 140 Commerce Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 3
Pursuant to written application, permission is here y ranted to the Licensed Drain Layer
named herein to perform the work indicated below at J � ��;i21,Yr C e�-T[ zV 6j.q
at premises owned by .��J e � 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 ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date . Estimated Time for Completion G111� ,
Permit to be issued to l
the holder of Drain Layer's License No. Zu Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer :h reby 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. I
Signed (&-c.J
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:
ll Engineering Department Date
lJU
Connection Charge Paid ���JG)' Permit Fee: Paid $ & U
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date