HomeMy WebLinkAboutDrain Layers Permit 49 Elm Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
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Pursuant to written application, � ---�-
Pp , permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at t
at premises owned by r r -1 it
y {rir S �2 whose address is
La House Drain �' and to
y , Repair House_ Drain, Lay Main, Other
Family Units, with acres.
for / ,, occupancy or use, with
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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) co2ies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion y'
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 aril 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. yl 7 /f
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Signed
Li ensed 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:
Engin ering Department Date
Connection Charge Paid %(1 Permit Fee: Paid $
Check Number J
Tax affice Issued by
INSPECTION
Date work started --Date--completed - -- -- - -
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Sufficient notification received: Yes No
Special Conditions
AP
APPR V _ _
Inspector Date