HomeMy WebLinkAboutDrain Layers Permit 596 Governors Highwa 77
TOWN OF SOUTH WINDSOR ,
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT m 4l
Pursuant to written application, permission is hereby grante /to the Licensed Drain Layer
named herein to perform 1:4�work ind'cated below at
at premises owned by - �Q/¢/ whose a ress 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.
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SPECIAL CONDITIONS
Desired Starting Date ;' %%/=5 Estimated Time for Completion '
Permit to be issued to r:"/4 <
the holder of Drain Layer's License No. ? o& 3 2 7. Permit will expire thirty (30) days
Y
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 Permit Fee: Paid $
/ 1 Check Numbed / 1
Issued by �2,
- ---- ---- -Tax Office _
INSPECTION /�
Date work starte - _
Date completed 4
Sufficient notification receiv d: Yes No
Special Conditions
APPROVED: G,
nspector DatLf
Construction Inspection Report
Project Date
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Work in Progress
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Problem Areas
Special Instructions/Orders