HomeMy WebLinkAboutDrain Layers Permit Main Line - Lakewood r: Y
TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT ? 3933
Pursuant to written application, permission is hereby grant to the Lie se Drain er
named herein to. perform the work indicated below at c
at premises -owned by Ts w ose 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 pzoposed work or furnish two (2) copies of'-separate drawings.
SPECIAL CONDITIONS
i
Desired Starting Date Estimated Time .for Completion
Permit_ to "be'issued •to
the holder of Drain` Layer's ,Licerise No. Permit will ekpirb!thirty '(30)'.days
after date of issuance. The undersigned Drain Layer reby agrees .to_ all the erms, and
conditions set forth in the permit and the reverse sid thereof. Applicant ` 'received
Town Permit No. and/or CHD .Permit No.
Signed
Licensed -in aye_
The above named Drain Layer has- a valid li` nse' issued by the State'•of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Ap_
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ 16 66)
Check Number
`.` Issued by
Tax Office71,
-
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
-__ -Specials Conditions
APPROVED:
Inspector Date