HomeMy WebLinkAboutDrain Layers Permit 1523 Main Street (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 5280
19_d�7
Pursuant to written application, permission is hereby granted to t e Licensed Drain Layer
named herein to perfo the work ind'cated b ow at
at premises owned by whose address is
u i
Lay House Drain, Repair House Drain, Lay Mai and to
for n, Other Family Units, with acres. occupancy or use, with
Type of sewage to be connected under this permit: SANITARY SEWAGE �e), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
x
1 '
SPECIAL CONDITIONS ;
0
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. b Permit will expire thirty (30) days
after date of issuance. The undersigned Drain La er 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 file/d� a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge PaidU Permit Fee: Paid $
Check Number
"4, 4c. Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
Ve