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HomeMy WebLinkAboutDrain Layers Permit 401 Governors Highwa (2) fir TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 3901 _ bl Pursuant to written application, permission is hereby Aanted to the Licensed Drain Layer named herein to. perfo the work inclicated below, at at premises owned by ', whos7 address 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` O C©nnecton will be-made with Show sketch of proposed work or furnish two (2) copie's of separate drawings. j SPECIAL CONDITIONS Desired Starting Date Estimated Time for :Completion . Permit- to be issued to the holder of Drain`Layer!s -License No: Permit will expire 'thirtyi (30) days after date of issuance. ' The undersigned Drafn�Layer hereby agrees_ to'all the terns-and conditions set forth in the permit and the reverse side thereof. Applicant has received Town Permit No,. p : and/or;CHD Permit No. Signed Licensed Drain•Layet The above named Drain gayer has a valid license issued by the State.`bf"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 $ M Check Number -.Z C - - -_ . ---- - -- �suea by Tax__4ffice INSPECTION Date wor starte Date comp eted Sufficient notification received: Yes No - Special Conditions APPROVED: Inspector Dane