HomeMy WebLinkAboutDrain Layers Permit 325 Dart Hill Road TOWN OF SOUTH W I N D►SOR
DEPARTMENT OF PUBLIC WORKS
'. BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �o
3646
Pursuant to written application, permission is heresy ranted t the Licensed Drain Layer
named herein to perform the work indi ated .below at.
at premises owned by }� whose:address is
and -to
Lay House Drain, Repair--House Drain,` 'Lay''Main, Other. ,
for occupancy, or use, Stith
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( INDUSTRIAL
WASTES ( ), OR' ( } Connection will_ be;made with
7/ G
Show sketch of proposed work or furnish two (2') copies of separate drawings:
SPECIAL CONDITIONS
Desired Starting Date >` Estimated Time for::Completion
Permit- to lie issued to
the holder of Drai}}'Layer's - icense No. Permit twill 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, the name of the'Town 'of_$outh`Windsor:
r:
Engineering Department. Date
Connection Charge Paid 0 y ' permit Feel Paid $ 1�rLo
Check Number/
1)11ue_.0 Issued by
} Tax Of
4
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate