HomeMy WebLinkAboutDrain Layers Permit 217 Natsisky Farm Ro TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
�1 ^' BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ` jp, 5073
07 �
19 i
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated;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 SANITARY -INDUSTRM
WASTES ( ), ORpermit.� Connection will�be -made with
Show sketch of proposed work or furnis two (2) copies of separate drawings.
1-1
SPECIAL CONDI IONS
Desired S rtin Da C
g Estimated Ti for Completion
Permit to be issued to .
the holder of Drain Layer's Licens Igo. Permit will expire thirty (30) days
after date of issuance. The unde7igned Dra' Layer hereby agrees to all a terms and
conditions set forth in the permit and the reverse side thereof. Applic t'has received
Town Permit No, and/or CHD Permit No.
i
Signed G't
is nse Drain Layer
The above named Drain Layer has a valid licen issued /ythe
; ate of Connecticut and
has filed a satisfactory bond and insurance polio' in the name of the Town of South Windsor:
7 Engineering Department Date
Connection Charge Paid Permit Fee: Paid
Check Number
\ Issued by
Tax Office
INSPECTION
\\Date work started Date completed
clent notification received: Yes No
Special Conditions
APPROVED:
Inspector Date