HomeMy WebLinkAboutDrain Layers Permit 54 Dower Road 1a5 . o TOWN
OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL s
DRAIN LAYER'S PERMIT n 5 4r 6 2
19�
Pursuant to written application, permission is hereby gr ted to th censed Drain Layer
named herein to perform work indicated below at
at premis owned by T- whose address is
Id
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with 1�
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 `Ei ((
Desired Starting Date t f_; - Estimated Time for Completiona,tLv 7, --
Permit to be issued to ,rY
the holder of Drain Layer's License No. , Permit will expire thirty (30) days
after date of issuance. The undersigneI Dra-1W 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:
Engineering Department Date
Connection Charge Paid � � q Permit Fee: Paid $ "
b Check Number -4*— _
Issued by -- ,
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date