HomeMy WebLinkAboutDrain Layers Permit 19 Hearthstone Drive (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL A
DRAIN LAYER'S PERMIT o, 4569
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Pursuant to writte%a�pati,Jj �ermiss n is hereby granted to the Licensed Drain Layer
named herein to perform H cSo catdbe o at :v __t :¢_
at premises owned byqzw/� 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 (4, 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 Z-- Z G -- �- 7 Estimated Time for Completion -Z G -o
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 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 in the name of the Town of South Windsor:
9ngine g�Department Date
Connection Charge Paid ! �% - G''�� Permit Fee: Paid $ I L
Check Number
Issued by
Tax Office
INSPECTION
Date work--started _ - Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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