HomeMy WebLinkAboutDrain Layers Permit 335 Diane Drive (2) • TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ® 3994
�Z 2 19 e�
Pursuant to written application, permission is hereby 9 antedcto t e Licensed Drain Layer
named herein to perform th work indicated below at J 3 S
at premises owned by J whose address is
Lay House Drain, Repair House Drain and to
; 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.
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 toe permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No. .
S igne LL
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:
Engineering Department Date
Connection Charge Paid '-IUD ^ 16 7 Permit Fee• Paid $ j L- �'
. .,�57�
Check Number 2
Issued by.
Tax Office
vNSPECTION
ate work started Date completed
Fficient notification received: Yes No
��;ial Conditions
APPROVED:
Inspector pate