HomeMy WebLinkAboutDrain Layers Permit Corner Ellington Roa T T WN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5082
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the,work indicated below at
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or usejN\with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITA9Y SEWAGE INDUSTRIAL
WASTES OR Connection will be made with
Show sketch of proposed work or urnish two copies of separate drawings. .V
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.
L
Signed
�- )
Licensed Drain , aver
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 tW- -n me of the;own of South Windsor:
An—gin-eering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
--Data-work started- 'Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVEQ,
Inspector pate