HomeMy WebLinkAboutDrain Layers Permit 15 Natsisky Farm Roa TOWN OF SOUTH WI N DSOR
� b DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �. 4649
19
Pursuant to written application,
PP , permission is hereby granted to the Licensed Drain Layer
named herein to perform t, ee work indicated below at
at premises owned b
Y whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres occupancy or use, with
.
Type of Sewage to
WASTES ( ), OR ( ) p6rmit: SANITARY , INDUSTRIAL
Connection will be made with
Show sketch of proposed ork or furnish two (2) copies of separate drawings.
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 thirt
after date of issuance. The undersigne Drain Layer hereby agrees to all the termsands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed E -� yv� F' r �- ✓
tensed D ain 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 i the name of the Town of South Windsor:
A
Engineering D�pent Date
Connection Charge Paid permit Fee: Paid v
$ 7
Check Number r�rr 9� Sl
Issued b
Tax of ice �.
INSPECTION
Date work started
SuffWlent notification received: Yes No
Special Conditions
APPR Inspector ` Date -�
r'