HomeMy WebLinkAboutDrain Layers Permit 580 Miller Road- F,. nr::-:�"t4 ..fr.=aw- ,.. � rr .. _ .•.yTa 't': .'a-4'":,pg"",-� } ai.
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TOWN OF SOUTH WI N DSOR
a�. DEPARTMENT OF PUBLIC WORKS
r• ) ���` f�aq� BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1�No, 4691
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Pursuant to written application, permission is hereby, granted to the Licenged Drain Layer
named herein to perform the work indicated below et
at premises owned by 1.7 c { :vt r;�`� zL ,J, 'a ,.�� 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.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. _ Permit will expire thirty (30) days
after date of issuance. The undersigned D ain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse sid thereof Applicant has received
Town Permit No. and/or CHD Permit No.
Signed _
ens 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 Permit Fee: Paid $ !"i
Check Number
�. Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date