HomeMy WebLinkAboutDrain Layers Permit 45 Diane Drive r TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
^� BUREAU OF POLLUTION CONTROL
1
DRAIN LAYER' �S�S PERMIT 2.
19 ,f_, "
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work indicated be1Qw at V';
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 thi l J�permi SANITARY SEWAGEINDUSTRIAL
OR WASTES f/
( ) ( ) C, Connection will be made with
G
Show sketch of ,pyrroposed, 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 policZin,4h name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid
Check Number
Issued by
Tax Office
f
INSPECTION
Date work started Date completed 2
Sufficient notification received: / s No
Special Conditions �"-
APPROVED•
Inspector Date