HomeMy WebLinkAboutDrain Layers Permit 64 Debbie Drive t
TOWN OF SOYTH.' WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL {�
DRAIN LAYER'S PERMIT y3948
/ 19O S
Pursuant to written application, permission is h reb rante to the Lensed Drain Layer
named herein to perfo th or -indic ed eiow t ' L ;Z . 1 r4 .(_C 4
f at premises owned by whoseaddress is
and to
Lay House Drain, Repair_,House 'Drain, Lay Main, Other ,
T:
for occupancy or use, with
Family. Units, with acres.
Type of Sewage to be connected under this permit: SANPTARY SEWAGE' ( ), INDUSTRIAL
WASTES { ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings:
r
SPECIAL CONDITIONS \
�w.
1` Desired Starting Date Estimated Time for Completion
Permit. to be issued to
the holder of Drain.Layer'.s .License N?: Permit will expire thirty (3'0) 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 Layler•=.
The above named ai}i. Layer has. i valid license issued by the State. of Connecticut and
has filed a .satisfa6 ory bond and insurance policy in the nam f th Town
of Soath Windsor:
Engineering Department Date
Connection Charge Pai' (� , fC tS Permit Feet Paid'$
_ Check r 3l
Issued by
x Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date