HomeMy WebLinkAboutDrain Layers Permit 630 Foster Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4 6 3 9
Li _ l 19 c
Pursuant to written application, permission is hereby granted o th icenseo Drain Layer.,(
named herein to perform t work indicate belo. at
at premises owned by
i
whose address is
La House Drain and to
Y , 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' z(%"
l� 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, 'n the name of the Town of South Windsor:
�k.. 2 7_,y—_
Engineering Dep ent Date
- Connect-i-on--Cha-r-ge Paid
/- 'Dermot—Fee: -Ndd a
Check Number
--P-leeued by
Tax Office
INSPECTION
Date work started
eemp
Su ficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate