HomeMy WebLinkAboutDrain Layers Permit 182 Debbie Drive TOWN OF SOUTH, WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT (�. 4307
gZ 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform t e work indicated be ow at 7
at premises owned by
whose address is
Lay House Drain, Repair House Drain, La and to
for y Main, Other
,
Family Units, with acres. occupancy or use, with
Type ^of Sewage to be connected under this permit: SANITARY SEWAGE ,
WASTES ( ), OR ( ) ( ) INDUSTRIAL
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 ;�Y 6^�7`
the holder of Drain Layer's License No. p 2 Permit will expire thirty
after date of issuance. The undersigned Drain ayes hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. licant has recei
Town Permit No. and/or CHD Permit No.
Signed
censed Drain L
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy` e name of the Town of South Windsor:
gineering Departmen Date
Connection Charge Paid �S(� 3 Permit Fee: Paid $ � 7
Check Nu r 33 �
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date