HomeMy WebLinkAboutDrain Layers Permit 32 Grant Road VOWN ,OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
,:fie BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNOo. 5 0 3 1
jc� (�,6&ju- Road-
Pursuant to written application, permission is er y raj�ted yhe Licensed Drain Layer
named herein to. perfo the work Indicated below at b ����
at premises owned by / I 1
t ` whose address is
La House Drain and to
3' , Repair- House Drain, Lay Main, Other for 0
w
Family Units, with acres. occupancy or use, ith
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 por Completion
Permit to be issued to t
the holder of Drain Layer's Li 'e N r
ermit vil'r "ex ,re th rty (30) days
after date of issuance. The undersigne Drain Layer hereby agrees to all a 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
. .
___=ectien-Charge Pa -A), i -Permit Fee: Paid $ '-)
Check Number �r
Issued by
Tax office "�-•
INSPECTION
-__=-_-Date-work-sta-r-ted-- -- ---
- mate completed -- --
Sufficient notification received: es No
Special Conditions
APPROVED:
OF-
Inspector Date