HomeMy WebLinkAboutDrain Layers Permit 496 Miller Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' 5173
Pursuant to written application, permission is hereby, ranted to the ,Licensed Drain Layer
named herein to perform;tie Work, indicated below at z�fie;�) y
at preen' es gwned ,> �� �� til� _{ ' Y � „_t.�, whose address is
rAuc'' ` uo and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, w' h
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.
SPECIAL CONDITIONS
To, ,
Desired Starting Date Estimated Time for Comp etion
Permit to be issued to y c,. r
the holder of Drain Layer's License No. t}o��- y . Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the v;_rms and
conditions set forth in the permit and the reverse side�t�� of, A i ant h received
Town Permit No. and/or CHD Permit No.
Signed j
L censed/Dr*in Layer
The above named Drain Layer has a valid license issued by the Sta of Connecticut and
has filed a satisfactory bond and insurance policy in,,,tife name of the Town oaf South Windsor:
Engineering Department/ Date
Connection Charge Paid 4/1Q(,,o �� Permit Fee: Paid $
Check Number r> ;
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: �Z
Inspector pate