HomeMy WebLinkAboutDrain Layers Permit 660 Ellington Road i
TOWN OF./SOUTH WI N DSOR
i.JEPAR ENT OF PUBLIC WORKS
UREE OF POLLUTION CONTROL
`DRAIN LAYER'S PERMIT 5113
Pursuant to written application, permission is her ran to the L ed Drain Layer
named herein to perform he work i. tdicated be ow a
at premises owned by L - whose address is
Lay'-House Drain, Repair House Drain, to
Lay Main, Other ,
for ` occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under his pt: SANITARY SEWAGE ( , INDUSTRIAL
WASTES ( ), OR � �r C b
onnec io ill e made with
TM
r ermi
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS � e
Desired Starting Date Estimated, Time�for Coiipil,etion
Permit to be issued to CONS%- "no
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 rec ed
Town Permit No. and/or CHD Permit No.
Signed
L ensed Drain L
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy i the name of the Town of South Windsor:
Engineering Department Da e
Connection Chs aid C Permit Fee: Paid $ J`T
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROVED:
Inspector—