HomeMy WebLinkAboutDrain Layers Permit 40 Farmstead Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL �T
DRAIN LAYER'S PERMIT N�. 5040
Pursuant to written application, permission is hereb granted to t1je Licensed Drain Layer
named herein to perform a wo i dicated
at premises owned by Q- whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
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) co_pao eparate drawings.
GA �
SPECIAL CONDITIONS
Desired Starting Date Z Zs. Estim ed Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 0�. 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.
Signed ,k,.,,
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 in the name of the Town f South Windsor:
Engineering DepartmkalK
//ll Date
Connection Charge Paid good 06 Permit Fee: Paid $ f�t:QU
Check Number
t
Issued by
Tax Cf f ice
INSPECTION
Date work started 2, S Date completed Z�
Sufficient notification received: Yes No
Special Conditions
APPROVED•
Inspector pate