HomeMy WebLinkAboutDrain Layers Permit 614 Foster Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ti
DRAIN LAYER'S PERMIT ®, 5086
Pursuant to written application, permission is her by rgated to he Licensed Drain Layer
named herein to perform the/97ork indicated below at J,,�,,
at premises owned by c��,� 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) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date t Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 4,,'7 0j -?,n 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:
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Engineering Departm n / Date
-77_ y�. - - �
Crm„prr;-r,,, -ChaPaid= - _ _- -� _ --=Permit= 'ee—
J Check Number-
Issued byTax Office
Office
INSPECTION
Sufficient notification received: Yes No
Special Conditions
/01
APPROVED:
nspector Date
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-TO help locate your sewer connection on the mainline e
where you would Like- the connection b � Pl-�Se show
the septic tank to the main line in the Stdreet ing a line From the house or
to indicate ti:1e as shown on sketch. Also, install stake in yard
the Town Engineering Department. I�you have any doubt•Please contact
Please draw important information such as driveways
and other obstructions, large trees
PLEASE MAIL THIS FOFRM II\/1NIEDIATELY TO;
JAMES S. MINGE-S ASSOC. , INC.
The Exchange
F=arrningtdn Avenue
Farmington, Connecticut 06032
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