HomeMy WebLinkAboutDrain Layers Permit 203 Foncine Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �. 4478
163
Pursuant to written application, permission is h reby granted to the Licensed Drain Layer
named herein to perform th, wo -�c indicated below at46
at premises owned b ' `
y `�' whose address is
Ut and to
Lay House Drain, Repair House Drain, Lay Main,
for Other
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. a Gam 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 E3in 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:
r�
Engineering Depart ent Date
--Conne -- Charge Pahl-J; _--
t` ,. Permit Few:-Paced—
Check Numberx.
Issued by
Tax ffice
INSPECTION
- - Date yQ.rk started Date
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date