HomeMy WebLinkAboutDrain Layers Permit 41 Devonshire Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q3870
19 Lj--
Pursuant to written application, permission is hereby granted tc� the Lensed Drain Layer
named herein to. :per£orm the work indicated below at f( D ,�, y
at premises owned' by5 ;whose address is
and to •_ .
Lay House Drain, Repair House'Drain; _'Lay Main, Other ,
for - occupancy, or"u—se, 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 Startling Date Estimated Time -for Completion.
Permit_ to be i_s sued to
the holder of Drain Layer'sLicense: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,Conn and
has filed a satisfactory bond and insurance policy .in the name-of the Town of South 'Windsor:
a /
Engineering.Depa:rtmen-t Date
Connection Charge Paid . �(Od 6 J Permit 'Fee: Paid "$ 0d.
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date