HomeMy WebLinkAboutDrain Layers Permit lot 2 Foster Road h D
TOWN OF SOUTH WI N DSOR
yi D DEPARTMENT OF PUBLIC WORKS
j BUREAU OF POLLUTION CONTROL
la' �l . • � j:p
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is hereby, granted to the Licensed Drain Layer
named herein to perfo he wor indicat d below at
at premises owned byc.96y L//%La %L 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.
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161
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 thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all theterms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed .717
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 $
Check Number
4. Issued by
Tax @ffice ��
NNED
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
- Special Conditions
APPROVED:
Inspector Date