HomeMy WebLinkAboutDrain Layers Permit 18 Dower Raod TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �o, 4708
6 19
Pursuant to written application, permission is here granted o the Licensed Drain Layer
named herein to perform the work ind'cated low at _�� _1A1' f
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 furnish two (2) copies of separate drawing .
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SPECIAL CONDITIONS
Desired Starting Date Es imated Time for Completion
Permit to be issued to CL-,
the holder of Drain Layer's License No. ;90 Permit will expire thirty (30) days
y
after date of issuance. The undersigned Drain L yer 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: `
Engineering Department Date
Connection Charge Paid Permit Fee: Paid
Check Ijupjper
Issued by
Tax Wffice
INSPECTION
Date work started 9 Y7 Date completed 9 7
Sufficient notification received: Yes No
m \ ;
Special Conditions
APPROVED: - -�%
Insp ctor Date