HomeMy WebLinkAboutDrain Layers Permit 289 Dart Hill Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT i3634
19 04`_
Pursuant to written application, permission is hereby g anted to the Licensed Drain Layer
named herein to. perform the work indicated below at •6cf.cj 9"41
at premises owned by1 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 a it: S ITARY SEWAGE , INDUSTRIAL
WASTES ( ), OR -( } '` ^ Connection will be;made with
Show sketch of proposed' work or furnish o (2) copies of- separate drawings.'
SPECIAL CONDITIONS
` Desired Starting Date Estimated Time for Completion .
Permit_ to issued issued to
the holdef of Drain' Layer's License No. Permit will expire thirty (30),-`days
after date of issuance. The undersigned Dra—' in'Layer'hereby agrees .to all tho_ 'ierms 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 �nsurance. policy_` in•.'the name of the Town'of Sadifi_Windsor:
C 7 y�s=
Engineering Department ..pate
Connection Charge Paid Permit Fee:' Paid $
Check Nu
Issued by
Tax Offis
INSPECTION"'
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date