HomeMy WebLinkAboutDrain Layers Permit 21 Avonwood Drive TOWN OF SOUTH W`INDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL .7
DRAIN LAYER'S PERMIT
y 190 �
Pursuant to written application, permission is her ra ed to the Licensed Drain Layer
named herein to perform wor}� indicated:below &L �))
at premises owned by /rC whose-address is
and to;.
Lay House Drain, ` Repair House 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`.
i
SPECIAL CONDITIONS
Desired Starting -Date EstimatedTime 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 `terins 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 name of the Town of South Windsor:
Engineering Depar _e_nt�y Date
Connection Charge Paid �/
g � �� Permit Fee! Paid
Check Number —zoa-3/
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date