HomeMy WebLinkAboutDrain Layers Permit 174 Debbie Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT off, 4261
Pursuant to written application, permission is hereby gr�lnted tQ the Licensed Drain Layer
named herein to perform the work indicated,- elow at J�.t `�at premises owned by
y1 r whose address is
Lay House Drain, Repair House Drain, La Main and to
for y , Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( INDUSTRIAL
WASTES ( ), OR ( )
Connecti will be made with
Show sketch of proposed work or furnish two (2) cop s f separate drawings.
5
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to )
the holder of Drain Layer's License No.
Permitxpire thirty (30) days
after date of issuance. The undersigned ill e Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof,
Town Permit No. and/or CHD Permit No. ppl. t has received
Signed
icens Drain Layer
The above named Drain Layer has a valid license issued by the tate of Connecticut and
has filed a satisfactory bond and insurance policy n e name of the Town of South Windsor:
r
Engineering Department Date
Connection Charge Paid
Permit Fee: Paid $ L, 60
Check Number
� �✓'J'� _ 1 - U`�--' Issued by
Tax Office
,i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date