HomeMy WebLinkAboutDrain Layers Permit 331 Dart Hill Road TOWN OF SOUTH Wf N DSOR .
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q 3647
Pursuant to written application, permission is her ranted the Licensed Drain Layer
named herein to perform:-the work indicated :.below ;at #� 31
at premises owned by whose;address is
and to
Lay House Drain, Repair House:Drain, _ gay Main, _ Otlier ,
for occupancy or use;`with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE WL , NDUSTRIAL
WASTES ( ), OR ( ) ,:.Connection will be made with
Show sketch of proposed.work or furnish two (2) copies of"separat'e drawings.
SPECIAL CONDITIONS
Desired Starting Date « Estimated Time :for::Completion
Permit- to ;be issued to'
the holder of Drain Layer's License'No. Permit will expire thirty (30)I'``days
after date of issuance. The undersigned Dra� in Layer hereby agrees to"a4"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, bona. and insurance policy in tfie namg:of the 'down af' South;`Windsor:
Engineering .Department Date
Connection Charge Paid '1160•U U Permit 'Fee!' Paid $
Check Number ny�
Y ��./J'n�vr_cIssued by
" �T�ax Off is
NSP CTION
ate work started Date completed
ufficient notification received: Yes No
ecial Conditions
APPROVED:
Inspector Date