HomeMy WebLinkAboutDrain Layers Permit 39 Elm Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5281
19r
Pursuant to written application, permission is hereby . ranted to the Licensed Drain Layer
named herein to perform the work indicated below at 1jq Vlll
at premises owned by
whose address is
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Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this pe i SANITARY SEWAGE (I WASTES ( ), OR ( ) !� �}, tj� NDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL C0 ITIONS
Desired Starting Date _ Est' ated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will ex
after date of issuance. The undersigned DDrain La er hereby agrees torallhtheyterms 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 t e name of the Town of South Windsor:
del
Engineering Department Date of
Connection Charge Paid QQ r 0 Permit Fee: Paid $ , D
Check Number
�- Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: yes No
Special Conditions
APPROVED:
�Ins�ectOr���4��:te �
Construction Inspection Report
• Project Dater
Street Time q,` --
; as
Weather o Insp.
Developer onfroclor
Work in Progtcl�
. �C
Problem Areas
Special Instructions/Orders
•