HomeMy WebLinkAboutDrain Layers Permit 163 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ®. 4197
t
19�:
Pursuant to written application, permission is ereby . ranted to the Licensed Drain Layer
named herein to perforr4,,the work indicted low at o �, (ar
at premises owned by whose address is
Drain and to
Lay House , Repair House Drain, Lay Main, Other
for occupancy or use, ith
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE , NDUSTRIAL
WASTES ( ), OR ( )
Connection will be made with
C, .
Show sketch of proposed work or furnish two (2) copies of separate dr ngs.
.fie f jam,
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 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 i e name of the Town of South Windsor:
-/,Z") �-- / ?
Eng veering Depa tmerit' 'Date
Connection Charge Paid `� � -�� j
g _ Permit Fee: Paid $
Check Number �Eo
A
f Issued by
V Tax Office
INSPECTION
Date work started j Date completed
Sufficient notification received: Yes _ G No
Special Conditions
Ins ecto '
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