HomeMy WebLinkAboutDrain Layers Permit 701 Graham Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
D/ DRAIN LAYER'S PERMIT
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19'D
Pursgant to written application, permission is hereby ant to the hicensed Drain Layer
named hergin to perform the 4ork indicated below at
at premises duned ,by ( ' whose 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 ( ) Connection will be:made with
Show sketch of proposed. work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion.
Permit- to be issued to
the holder of Drain Laye•r'.s •License No. 'Z,G 37� ; Permit will, expire``thirty '(30) `days
after date of issuance. The undersigned Drain Layer hereby .agrees -to ;all ;the teki4 and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No.. and/ov 016 Permit No.
Signed _
Lieensed 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 n the nOmp of.`the Town of .9outh' indsor:
-Engineering Department ;Date
Connection Charge Paid Permit Fee:' Paid '$
Check Number
-f I 'Ittc-
------- --- --- Tax of 'ce
INSPECTION
Date wor starte pate comp ete
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date'