HomeMy WebLinkAboutDrain Layers Permit 15 Evans Crossing TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT (�
•
1-5 &JaA%O 19 d'
Pursuant to written application, permission is named herein to perform th ork indicated below atre"ygra tedto the Licensed Drain Layer
at premises -owned' by �)
wh e::.address is
Lay House Drain, Repair House Drain, and :to,
for Lay Main, Ot_jjT
Famil acres
y Units, with occupancy or use; with
.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ,
WASTES ( ), OR -(' J ( ) INDUSTRIAL
Connection will be made-with
Show sketch of proposed work or furnish two 2 copies of separate drawings'.
{
SPECIAL CONDITIONS
Desired Starting Date Estimated. Time for Completion ;
Permit- to :be issued'to
the holder of Drain" Layer's License No ;1p 6 2 o i�r Permit will expire 'thirty` (30) days
after date of issuance. The undersigned Drain Layer hereby ,agrees.to all the`'terins and
conditions set forth in the permit and the reverse side thereof: 'Applicant has received
Town Permit No. and/or CHD Perm,�it; No.:
Signed
Licensed -Drain Layer
The above na ,ed
Axain Layer has;'a vai'd license.issued tSy the Sate``o£ Cinriectcut and
has filed a satisfactory bond and insurance policy-
_ - p y ,in the nam of'rtl a Town of $outh'Windsor:
Engineering Tepartment Date
Connection Charge Paid . �Permit Fee: Paid $ 1,6,
l` Check Number
�►;�n,C� ,( Issued by'`
Tax Office
INSPECTION
Date work startedSufficient notification received:
Yes No
Special Conditions
APPROVED:
Inspector Date