HomeMy WebLinkAboutDrain Layers Permit 60 Devonshire Drive iTOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF 'POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Coo Daonskxv c Dr. 19` --S
Pursuant to written application, permission is h7e Q ant to the Licensed Drain Layer
named herein to perform tJswor indi at.ed below at ,!- ,
at premises owned by //�� �� whose-address is
and to
Lay House Drain, "Repair House Drain, Lay Main, Other ,
for occupancy or use, witk
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 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 .in the name of the Town of South Windsor:
-915
Engineering Depa went .Date
r ?J7-
Connection Charge Paid ��. Permit Fee Paid $�J�i/ W,�I1
Check Number e-3
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date