HomeMy WebLinkAboutDrain Layers Permit 100 Hayes Road TOWN OF SOUTH WI N DSOR
r DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN.LAYER'S PERMIT, 5092
g4 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work"*ndicated below at Ito 41,--ag,4
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
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Type of Sewage to be connected under th' pe t. SANITARY SEWAGE ( , INDUSTRIAL
WASTES ( ), OR ( ) rr2! 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 Estima d Time for Completion
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Permit to be issued to
the holder of Drain Layer's License No. D ( 5 ' . Permit wi 1 expire thirty (30) days
after date of issuance. The undersigned Drain L yer 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 n he name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ /�)-,QJ
Check Number !j 3�7
Issued by
(-Y Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED•
Inspector Date