HomeMy WebLinkAboutDrain Layers Permit 122 Debbie Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4018`
�ZZ C:A , & , 19,
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer
named herein to perfo the work i icate below at /rf �}�ce e .
at remises owned b
P y � ILQ-r t whose address is
and >to°
Lay House rain;' Rei,,1r House'Drain; 'Lay Main, Oilier ,
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 .the terms 'and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or_ GHD Permit. No.,.;..;::.
Signed
s Licensed Drain Layer
The above named Drain Layer has a v's.lid license issued by the State of Connecticut and
has filed a satisfact.ory bond, and insurance policy. in the name of. the Towd`of'. South .Windsor:
�06 4 .
Engineering Department. -Date
Connection Charge Paid Permit Fee: Paid $
Check Number
i it CL Issued by
Tax Office
,
i,
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED
Inspector Date