HomeMy WebLinkAboutDrain Layers Permit 459 John Fitch Boule TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4938
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the indicated 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.
v n/ 0
SPECIAL CONDITIONS �5
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 agree to all the terms and
conditions set forth in the permit and the reverse side them plicant has received
Town Permit No.. and/or CHD Permit No.
Signed
Licensed rain Layer
The above named Drain Layer has a valid license i ed by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
E gineering Department Date
Connection Charge Paid y/C Permit Fee: Paid $
Check Number421
l Issued by
Tax Office j
INSPECTION
- - - - - p - -- - -. -
Da a work-"started -" � Z�--- - Date com leted � -� Z
Sufficient notification received: es No
Special Conditions
APPROVE
Inspe toe Date