HomeMy WebLinkAboutDrain Layers Permit 101 Foncine Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Xo, 4472
/ al , 19"
Pursuant to written application, permission is hereby ranted to he Licensed Drain Layer
named herein to perform the wor ind'cated below at �`
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
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) 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. 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
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 of South Windsor:
Engineering Department Date
Connection Charge Paid �J�/-r� ��3� Permit Fee: Paid $ I 0�J
Check NumberI 'A Ai . A .0.& �j 9
A141D
c
Issued by
Tax Office
INSPECTION
._Date -work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date