HomeMy WebLinkAboutDrain Layers Permit 201 Foncine Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Vol. 4476
Off` 1 , 19 z`P ;
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the wprk indicated below at �/ -y-yt_Cl
at premises owned by , 4- ,�j � 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. 010 7 ��" 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�z
s
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 Depart nt Date
- Connection Charge-_Paid_
- �-�-� � -���-�-- --Permit Fee•-Pai-d-� �!i.�--- -
Check Number t' tC
.
Issued by
Tax office
INSPECTION
Date work started
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date