HomeMy WebLinkAboutDrain Layers Permit 180 Governors Highwa TOWN OF SOUTH WI N DSOR �!
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 ;� 's
LC 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work" indicated below at XV
at premises owned by VIhoseI address is
and to
Lay House Drain, epair 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 J /, Estimated Time for Completion
5
Permit to be issued to
the holder of Drain Layer's License No. 1V`_S.`i /. "3 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 therp)o�. Applicant his received
Town Permit No. and/or CHD Permit No. L ' `L
Signed / y
-L,�e-ns rain 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 t Permit Fee: Paid
Check Number
Issued by . .
- - - - - Tax Office
INSPECTION
ate work started Date completed - -
Sufficient notification received: 4 ,1 Yes No
Special Conditions
APPROVED:
Inspe for Date