HomeMy WebLinkAboutDrain Layers Permit 16 Jessica Drive 77
TOWN OF SOUTR WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT S 1 409.5
C/9
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Pursuant to written application, permission is hereby granted o e Lic sed Drain Layer
named herein to perform he work ind�.c�:ted below .at �. `�. �/ _
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 ( ), 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 Estimated Time for Completion
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 tei�iris 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 T.own of: South-�Windsor:
rJ
Engineer ng • ep.artme .,Date
Connection Charge Paid �� Permit Fee: Paid $ &L.QC�
Check Numberrp
Issued by
Tax Office
INSPECTION
Date work started____ _-_--
Sufficient notification received: Yes No
Special Conditions _
APPROVED:
\ Inspector Date