HomeMy WebLinkAboutDrain Layers Permit 110 Highland Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 549!'
S-, (L , 9fL
Pursuant to written application, permission is hereby grant �
/e t th Licensed Drain Layer
named herein to perform the work indicated below at �-
at premises wne y 1 whose address is
CJ tan CJ C ✓_' and to
Lay House D a , Repair House Drain, Lay Main, Other ,
for P-o-s;cP_v c 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 tV�J►-Q.,
Desired Starting Date E timated T}me for Completion
Permit to be issued to ✓� Is�i`{L�S
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned rain aver 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:
r;�'�D
1 3 Engineering Department Date
Connection Charge Paid , Permit Fee: Paid $ S
Check Number
�✓�/i Issued by
Tax Office
_INSPECTION _
Date work started Date completed
Sufficient notification received: Yes - No
Special Conditions
APPROVED:
Inspec or pate