HomeMy WebLinkAboutDrain Layers Permit 152 Natsisky Farm Ro TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4895
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Pursuant to written application, permission is he eby granted to the Lice ed Drain Layer
named herein to perform—the wor ind Dated bw1ow at c�' �/
at premises owned by 7 /l_� ,L,,��„� whose address is
La House Drain and to
Y , Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit. SANITARY SEWAOE 1NDTJ5TK1AL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed w rnish two (2 copies of separate drawings.
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• SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to 7n
the holder of Drain Layer's License No. 20$ 9 1. 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 ece.
Town Permit No. and/or CHD Permit No.
ived
Signed
rl Licensed Dra Layer
The above named Drain Layer has a valid license issued by the State of of and
1was filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid � - � � 7 Permit Fee: Paid $
Check Number 3 2�
tl� y Issued by
i
Tax Office
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NSPECTION
Date work started Date- completed O
SUfficlent notitication received: Yes No
Special Conditions
APPROV
Inspector Date