HomeMy WebLinkAboutDrain Layers Permit 17 Meryl Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERM• T A Rm5291
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Pursuant to written application, permissio s hereby�gr n"d to he nsed Drain Layer
named herein to perform the work indicated bglow 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 (01/' INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
00 "'�4
SPECIAL CONDITIONS
Desired Starting Date '7 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Lice se No 8 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 , -4:27 Z��J
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:
Engin ring Depart Date
00
Connection Charge Paid A/O-� Permit Fee: Paid
Check Number
7�
Issued by
'Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROVED: U
Inspec r Date
Construction Report
Project Now
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Developer
Work in og S S
Problem Areas
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construction Inspection Report
• Project Da e
Street Time c,�.r e3o
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Weather
Developer Contr for
Work in Progress
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Problem Areas
Speciol Instructions/Orders
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