HomeMy WebLinkAboutDrain Layers Permit 177 Maskel Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NN0,. 4 6 9 5
L- 19
Pursuant to written application, permission is hereby grantod to'th Lir sed Drain Layer
named herein to perform the w rk indicated bel 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 ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
/7,
�y
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
/
Permit to be issued to l o d/,S
the holder of Drain Layer's License No. ^_ Permit will expire thirty (30) days
after date of issuance. The undersigned Drain L yer 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 filed a satisfactory bond and insurance polic n the name of the Tvm of South Windsor:
Engineering DepartmISnt Date
Connection�Char e Paid IWO Permit Fee: Paid $ J J �r7
Check Numbevl
7
Issued by �c
Tax Office
INSPECTION
Date work started ��^8 Date completed 7
Sufficient notification received: Yes No
Special Conditions �` �S7`r�
APPROVED: —3
Spector Date