HomeMy WebLinkAboutDrain Layers Permit 1713 Main Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 4
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the ork 'nd- ed below at 7j
at premises owned by -fJ J t whose address is
`L' and to
Lay„�se Drain, �_ Repair House Drain, - Lay Main, Other ,
for p�,,�t z i occupancy or use, with
Family Units, with 7— acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (X), INDUSTRIAL
WASTES ( ), 0,4 ( ) Connection will be made with
Show sketch of proposed work, or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date "'; i e j4L Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License 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
Towh.)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:
Engineering Department Date
Connection Charge Paid �X � `� Permit Fee: Paid $
Check Number C t
Issued by
Tax Office
INSPECTION
Date work start ---- ---- -- - -- Date completed —
Sufficient notification received: Yes No
Special Conditions
APPROVED; C
Inspector pate