HomeMy WebLinkAboutDrain Layers Permit 1511 Main Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT4 on
Pursuant to written application, permission is hereby granted o, the Licensed Drain Layer
named herein to perform.--the work ind c ted below at P �. � �
at premises owned by i:. ovy_�,-yl jx: o� whose address is
a
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.
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k
SPECIAL CONDITIONS
r
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. o Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Lay•r 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 ate.
License -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:
/i Engineering Department ll Date
Connection Charge Paid lM d•U y Permit Fee: Paid $
Check Number
Issued b y
Tax Office
INSPECTION
- Date-work—started- -� - ��---- Irate completed -I
Sufficient notification received: Yes No -
Special Conditions 1A.1
APPROVED:
Inspector Date