HomeMy WebLinkAboutDrain Layers Permit 18 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT XO 4245
le Nutk 19.�
Pursuant to written application, permission is hereb gran ed to the Li c nsed Drain Layer
named herein to perforqi the work indicAted below at
at premises owned by , r whose address s is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for I occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O, 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 Estim ted Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. a it 11 expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms an
conditions set forth in the permit and the reverse side ther of. pplicant has rec v d
Town Permit No. and/or CHD Permit No.
Signed
V--Iicensed Drai La
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy i e name of the Town of South Windsor:
a z7- -5-X
Engineering Department Date
Connection Charge Paid ( � � '"y,' j Permit Fee: Paid $ j U 0
Check Number �,J
Issued by
Tax Otfice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date