HomeMy WebLinkAboutDrain Layers Permit 20 Diane Drive TOWN OF SOUTH
WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5250
, 19
Pursuant to written application, permission is hereby . ranted to�the Licensed Drain Layer
named herein to perform th w ind(at d belojw at
at premises owned by 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 furnis (2) copies of se arate drawings.
V"
SPECIAL CONDITIONS ,
Desired Starting Date Estimated Time for Completion
Permit to be issued to &A= G
the holder of Drain Layer's License No o S-0 71 . 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
Ificens-eWDkain 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 i t name of the Town of South Windsor:en
Engineering Departmt Date
Connection ge Paid v7 Permit Fee: Paid $ � 3 )��6
Check Nu r
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date