HomeMy WebLinkAboutDrain Layers Permit 45 Krawski Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT l0 4129
Pursuant to written application, permission is hereby
named herein to. perform the w rk indicated below at �, lY granted to the. Lic�nsed Drain Layer
at premises owned b �`' �� - 110 it"f t
y. 9- a � 2, -- whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE
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 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 in the name of the To of South Windsor:
y- z 3 -e6
Engineering Departm t Date
Connection Charge Paid 1-I0d G y Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date comA+�eted
Sufficient notification received: Yes No
Special Conditions
APPROVED: --
Inspector pate