HomeMy WebLinkAboutDrain Layers Permit 29 Kelly Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT e. 4415
Pursuant to written application, permission is hefeby gran ell to t, g Licensed Drain Layer
named herein to perforp the.work tndi ted below at -
at premises owned by !� `1 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 terms 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 �n the name of the Town of South Windsor:
Engineering Deg rtment Date ,
Connection Charge Paid �}+, i��'� �i- ' Permit Fee: . Paid $
Check Number t:
Issued b
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yep No
----Spec ial Conditions
APPROVED:
Inspector Date