HomeMy WebLinkAboutDrain Layers Permit 820 Foster Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
•
'M Rbs4er S+ . V 2---, 19
Pursuant to written application, permission is hereby granted to t Licensed Drain Layer
named herein to. perform th work ind cated below at �`!3
at premises owned by S 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.
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 - - _ /7i �� _ - Permit- Fee: Paid -
check Nuzqber
Issued by
Tax Office
INSPECTION
`Date_work- s_tartpd. _ Date completed-
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date