HomeMy WebLinkAboutDrain Layers Permit 48 Goose Nest q,..+r
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT &0. 4991
1111)11K) , 19
Pursuant to written application, permission is here y granted to the Licensed Draier
named herein to perform the work d', ated below I '
at premises owned by hose 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 Z-d�- g� (( Estimated Time for Completion 3 )M6NtS N
Permit to be issued to `1 5LAXt—w- S C6. I IliC.
the holder of Drain Layer's License No. Permit will e ire 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 r thereof. Applicant has received
Town Permit No. and/or CHD Permit No. r�
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:
Engineeri~g Department Date
Connection Charge Paid A� Permit Fee: Paid $ j S
Check Number -
Issued by � � l
Tax of f ice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
- _ Special_Conditions -
APPROVED:
Inspector pate