HomeMy WebLinkAboutDrain Layers Permit 160 Debbie Drive M TOWN OFF SOUTH ; WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU=OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q 4996
19 0(�-
160 �kbhieF(Z)dvt
Pursuant to written application, permission is hereby grante to t e Lice sed Drain Layer
named herein to perfo they work indi aged elow.at19�€- .�p0,
at premises owned by whoseYaddress is
< and to
Lay House Drain-, Repair 'Mouse 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.
SPECIAL CONDITIONS '
Desired Starting Date Estimated-:Time for Completion
Permit. to be' issued- to
the holder of Drain `Layer's -License No. Peii-it will expire-thirty (3U) "days
after date of issuance. The undersigned Drain Layer hereby .agrees. to "all thd `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 Drain Layer has a valid license issued by the State. of Connecticut and
has filed a satisfactory bond. and insurance policy in the na . "Windsor:`
Engineering-�Department< Date
Connection Charge Pad h� �17' Permit Fee: Paid` -$
Check Number
2( = Issuedd by
Tax Office
J
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date