HomeMy WebLinkAboutDrain Layers Permit 32 Highland Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT €' ' 5277
Pursuant to written application, permission is hereby granted to„the Licensed Drain Layer
named herein to perform the work indicated below atr
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 (0, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two,1(2) copies of separate drawings.
f f'� .C
AI
ti.
SPECIAL CONDI 0 S
Desired Starting Date Estima Time or Completion / �G
Permit to be issued to V ,V
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 al he erms and
conditions set forth in the permit and the reverse side thereof. p 1' a h received
Town Permit No. and/or CHD Permit No.
Signed
icensed Drain_k:ayer
The above named Drain Layer has a valid license issued by the S ��9�6connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engin(ier' epartm Date
Connection Charge Paid &.)d Dii Permit Fee: Paid $
Check Number
s� :�JiZl:f.C: 1 Issued by
f j Tax Office
INSPECTION � e9
Date- work started f i c; I Date completed
Sufficient notification received: es No
Special Conditions
APPROVED:
nsp ctor Date