HomeMy WebLinkAboutDrain Layers Permit 49 Hearthstone Drive TOWN OF SOUTH WINDSOR Y9
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 49 4
2,.__ 19 �
Pursuant to written application, permission is hereb (anted to the Licensed Drain Layer
named herein to perform the work indic ted )low at s
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.
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
_Ll t w
the holder of Drain Layer's Licen a No. olr Z Permit will expire thirty (30) days
after date of issuance. The undersi in Layer 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 ,N�
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:
ngineering Department 1 Date
i
Connection Char a Paid 1��� 17i Permit Fee: Paid $ f /L- r_(Ay L
Check NuMb
Issued by '
Tax Office
INSPECTION
Zate work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date