HomeMy WebLinkAboutDrain Layers Permit 15 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0J r
19 6
Pursuant to written application, permission Iis he by granter t he L' ensed Drain Layer
named herein to. :perfo the wo ]]- ind' ated.below at premises 'owned"bar' 1Q ( whose address is
and :to
Lay House Drain, Rep`a ir'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
. t
SPECIAL CONDITIONS
Desired Starting'Date Estimated:-Time.for Completion
Permit. to `be issudd-to
the holder of Drain Layer's'License No.` ' ' Permit will_ expire 'thirty (50)'°-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 Dta nz.Layer has A Valid license issued by the`state' of Connecticut and
has filed a satisfactory- bond' and insurance:policy. in.the name of tyre Town of South`Windsor:
v v
Engineering Department ..Date
Connection Charge Paid OPg Per it Feed Paid $ J,)7z UO
Check Number l
�'L l Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date