HomeMy WebLinkAboutDrain Layers Permit 400 Foster Road (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 'F " r. 4
Pursuant to written application, permission is hereby gra ed to t Licensed Drain Layer
named herein to perform the work indicated below at0T�S/ ;�'
at premises owned,. by (gip whose address is
-o ti_ y and to
for
Lay' House Drain, r � Repair House Drain, Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE (/�Q, 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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0P CIAL CONDITIONS
r�
Desired Starting Date ) - Estimated Time for Completion
Permit to be issued to A r,
the holder of Drairi Layer's License No. 2- ,-),� Permit will expire thirty (SO) days
after date of issuance. The undersigned Drain Lay rthereby 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 polic in the name o the Town of South Windsor:
E gine r'ng Department Date
j
c ion-Charge_Paid �c -- -- - --- -- ----- -�- - �� - - ---- -
hermt Fee: Paid $ ,
heck Number
-- Issued by
Tax Office
INSPECTION
Date completed /O /O
Sufficient notification received: Yes No
Special Conditions
APPROVED:
nspecto Date
Construction Inspection Report
Project
Street
,4(op��s � � Time
�6 d
Weather Insp.
Developer Contractor
Work in Progress
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Problem Areas
Special instructions/Orders