HomeMy WebLinkAboutDrain Layers Permit 24 Pintail Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1 fie, 4239
19 -
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform th=w �2ndicated below at
at premises owned by 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 proposedw�o'rkQ or furnish two (2) copies of separate drawings.
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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 in the name of the Town of South Windsor:
LAnjiheering Department Date
Connection Oharg5� Paid Z-ff'7) Permit Fee: Paid
jCheck Num.er
� � .
Issued by z'fM
Tax Office
i INSPECTION
Date work- started Date completed
Sufficient notification received: Yes No
-_-- Special Conditions
APPROVED:
Inspector Date