HomeMy WebLinkAboutDrain Layers Permit 22 Darlene Drive r!}
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT dTo. 4391
19
rsuant to written application, permission is h reby grant d to-the Licensed Drain Layer
herein to. perfo he w k indicated below at 1-C,1_
emises owned by whose address is
and to
House Drain, Repair House Drain, Lay Main, Other ,
r occupancy or use, with
amily 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
Permit to be issued to
the holder of Prain Layer's License No. Permit will expire thirty (30) days
Y
after date of issuance. The undersigned Drams yer hereby agrees to all the terms and
conditions forth in the permit and the reverse side thereof. Applicant has received
Town P_ermkie No. and/or CHD Permit No.
Signed (�
Licensed Dra n 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 the name of the Town of South Windsor:
Engineering Departik5A Date
Connection Charge Paid i�` ..�/ `7 / Permit Fee: Paid $ U
Check Number )
0 (_>_.._Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date