HomeMy WebLinkAboutDrain Layers Permit 14 Miller Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby,granted.to the-, Licensed Drain Layer
named herein to perform "the work indicated below at ` ' °=`
whose address is
at premises owned by -} t`
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 pe it: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) r� r _� Connection will be made with
Show sketch of proposed work or furnish two (2 copies of separate drawings.
0c jV rr
SPECIAL CONDITIONS ?
Desired Starting Date 15P% Estimated Time for Completion c 61 }f
Permit to be issued to
the holder of Drain Layer's License No. K 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 T2 am
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 thp- name of the jx of South Windsor:
Engineering De went Date
Connection Charge Paid r,: Permit Fee: Paid $
Check Number
rr Issued by
Tax Office
INSPECTION 9 —F,
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED A
Inspector Date
Construction Inspection Report
Project Date
-A,
Street f�' 4A Z Time 9
Time
o 9
Weather In
�4
Developer Contractor en
Work in Pro ress
l
O
Problem Areas
Special Instruct ions/Orders