HomeMy WebLinkAboutDrain Layers Permit 36 High Tower Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3
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Pursuant to written application, permission is h re y rant d to the Licens d Drain Layer
named herein to. perform the work ndic ed :b low atz ��
at premises `owned by` whose address is
and .to:
Lay House Drain-, Repair House 'Dra.iri 'Lay Ma h, 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:Start higDgte Estimated--Time foriCompletion
W
Permit_ to ''fie 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 r
Lice ed 36rain 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:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $�`J ,D
Check Number 3
Issued by
Tax Office
INSPECTION
Date work started _ - - - - -Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date