HomeMy WebLinkAboutDrain Layers Permit 18 Garnet Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ?_ 4--
19 4
Pursuant to written application, permission is hereby grant to the L censed Drain Layer
!r named herein to. perform he work indicated below at �)f a� ;� —
at premises 'owned by whose address is
and to
Lay House Drain-," ' Rep'nir ouse 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 O, 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 StartllngDate 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:
Ili
d , Engineering Department Date
Connection Charge Paid . D Q .p y Permit Fee: Paid $ d
Check Number lUyyg�
Issued by _
- Tam--Af fiGe----
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special--Conditions
APPROVED:
Inspector pate