HomeMy WebLinkAboutDrain Layers Permit 25 Garnet Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS,
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT, 3851
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A5 , 1
Pursuant to written aapptica--tion, permission is Per by gra d to t e icensed Drain Layer
named herein to. perfo t e work indicated below at-
at premises owned by whose address is
and to
Lay House Drain, Repair House .Drairi, 'tay in, Other ,
for '— pccupancy o 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 bf separate drawings.
SPECIAL CONDITIONS
Desired Start3n`g Date Estimated Time for.Completion
Permit. to be issued to
the holder of Drain Layer'- Lic'ense 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 naive of the `Town of Sbuth`Windsor:
Engineering Department Date
Connection Charge Paid d Permit Fee: Paid $ J d
Check Number / yo
I§sued Uy
Tax_-A f.ice - - -- - --
INSPECTION
Date wor7 Rairred Date completed
Sufficient notification "received: Yes No
Special Conditions
APPROVED:
Inspector pate