HomeMy WebLinkAboutDrain Layers Permit 70 Jessica Drive TOWN OF SOUTH WI N DSOR
�`'.2 DEPARTMENT OF PUBLIC WORKS
BUREAU. QF POLLUTION CONTROL
DRAIN LAYER'S PERMITr� � 4997
Pursuant to written application, permission is hereby granted,to e_Lic sed Drain Layer
named herein to perform,the work indic tied ebb low at
at premises owned by � E.h� t� '�rp. 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.
r
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 (3aj"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 C.HD •Permit No.
Signed:
Licensed":-Drain Layer
The above named Derain Layer has a valid license issued by the 'State-or Connecticut and
has filed a satisfactory bond and insurance policy." the nam ='the of'S'oiith Windsor:
26
Engineering epart t Date
Connection Charge Paid Permit Fee': Paid" $ ,, vA.)
Check Number
✓ Y2�! -.0 � � ��-i-1 Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
_Special Conditions
APPROVED:
Inspector Date