HomeMy WebLinkAboutDrain Layers Permit 1210 Main Street r
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
i DRAIN LAYER'S PERMIT .t `o', 4694
19
Pursuant to written application, permission is hereby grakf ed;to the Licensed Drain Layer
named herein to perform the work indicated below at -
at premises owned by r-0l �40se address is
t.�•,,,�� and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for r , . occupancy or use, with
Family Units, with acres.
Type of .Sewage to be connected under this permit: SANITARY SEWAGE f(..�), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion „-
s t
Permit to be
the holder of Dsair 1,aye�!s. License No. f = ,' Permit wi expire thirty (30) days
after date of issuance The undersigned Drain-'Layer'hereby 'ag es -a 1 tke,terms and
conditions set foifL4,•'in the permit"and th)e,reverse 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:
Of
-Nngi a ring D partment Dates
.Connection Charge Paid Permit Fee: Paid $
Check Number - -'
Issued by
Tax Office
. i.
INSPECTION
Date work at rted-- — 'Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate
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