HomeMy WebLinkAboutDrain Layers Permit 23 Main Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��yy
DRAIN LAYER'S PERMIT NNO, 4808
19u
Pursuant to written application, permission is he ebv granteo,to, the Licensed Drain Layer
named herein to perfor QtFhe work in ' ated b to aty� ,
at premises owned by� '�D F ! > 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 proposed work or furnish two (2) copies of separate drawings.
fAi
SPECIAL CONDITIONS
Desired Starting Date / Estimated Time for Completion
Permit to be issued to %it/,
the holder of Drain Layer's License No. i e thirty
y �k�. 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 namf the Town of South Windsor:
Eng veering Departm nt Date
Connection Charge Paid �i ���- Permit Fee: Paid $
Check Number
Issued by '
Tax affice
INSPECTION PPAI LIAM PROPEL "POGS A/or At6EZP 7Z)CJ,J
Date work started Date comp ete
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate
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Developer
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Problem Areas
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