HomeMy WebLinkAboutDrain Layers Permit 26 Homestead Drive r TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
c DRAIN LAYER'S PERMIT NO ��1*
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated Veow at
at premises owned by
whose address is and to
Lay House Prain, Repair House Drain, k,� Lay Main, Other ,
for 07to_ occupancy or use , with
Type of Sewage to be connected under this permit : SANITARY SEWAGEINDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketc of proposed work or furnish two (2) copies of separate drawings .
SPECIAL CONDITIONS
Desired Starting Date ``/O ^ !fZ- Estimated Time for Completion
17
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 .
S i g n e d
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 :
Engineering Dept . Date
Permit Fee Paid $ Check Number �6 off..
Connection Charge Receipt No . Dated
Issued by ��
INSPECTION
Date work started ate completed
Sufficient notification received : "yes No
Special Conditions
APP D /
Inspector Date