HomeMy WebLinkAboutDrain Layers Permit 111 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4084
/// C��rQ i ' 19
Pursuant to written application, permission is ere y nt d o,the Li ensed Drain Layer
named herein to" per£o the wo indic ted low t : 7P %P. r' -ad
at premises "owned "by , whose,address is
and to--
Lay House Drain," ` Repair House—Drain,' Lay Main,'
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.
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)"days
after date of issuance. The undersigned Drain Layer hereby agrees' to' all.. tie tertSg'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 .licens, 'ssued by tle'Stat`e w of `Connect cut and
has filed a satisfactory bgnd and insurance polic . n the name of the To `of.`South". Windsor:
Engineering Department Date
Connection Charge Paid �� �J ` Permit Fee: Paid-' $
Check Number
-4 1 411-z"e, Issued by
Tax ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date