HomeMy WebLinkAboutDrain Layers Permit 1291 Main Street (2) TOWN OF SOUTH---W1-N-DSOR =- - ---
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5273
Pursuant to written application, permission is hereb grante to a Licensed Drain Layer
named herein to perform the work i ica ed el w 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 under this permit: SANITARY SEWAGE (kf, INDUSTRIAL
WASTES �( ), OR V, C, Connection wi b made with
r
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Hit Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No 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
Lice s d 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 SouthWindsor
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111"4 5�7�1 Engineering Department Date
Connection Charge PaidA1,6-wPermit Fee: Paid $
Check Number �1214;
4
Issued by
g� Tax Office
INSPECTlIION
Date-wo-rk started - - _ - - -__ Date- completed _
Sufficient notification received: es No
Special Conditions
APPROVED: ,
Inspector pat