HomeMy WebLinkAboutDrain Layers Permit 60 Judge Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL `
DRAIN LAYER'S PERMIT ^"
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Pursuant to written application, ermission is hereby granted to,the Licensed Drai
named herein to perform, the work indicated low at n Layer
°be ,'; /�j "
at premises owned by Ate, f .
whose address is
Lay House Drain, Repair House Drain, La Main and to
for y Other
Family Units, with __ acres. occupancy or use, with
Type of s connected
WASTES ( ), OR ( ) under this permit: SANITARY SEWAGE ( INDUSTRLAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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S'CE' fFs SPECIAL CONDITIONS
CONDITIONS ����-7-
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. I;:-',�
after date of issuance. The undersigned Drain Layer hereby agreesXtorallhtheyterms ands
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 Town of South Windsor:
Engineering Department Date
Connection Charge Paid `/ Permit Fee: Paid $
Check NumberL��
k .%��u-
Tax Office Issued by
INSPECTION
Date work started
___ _ -
Sufficient notification received: -Date -completed_ �'
,� �-_ 2..
Special Conditions Yes No
APPROVED:
Inspector Date