HomeMy WebLinkAboutDrain Layers Permit Lot 5, Miller Road t
Aso TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
" BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT s Z 2 5 1 $6+`
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work iaa icated below at
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with j
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (i,-);-INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Da95Estimated Time for Completion
Permit to be issued to 1t4, e ,l
the holder of Drain Layer's License No. 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
'cen a Dra%n� 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 /yG', t.:t) Permit Fee: Paid $
Check Number
Issued by
Tax'Cif f ice
INSPECTION
Date work started Date completed
Sufficient notification received: _-4-,-- i'es No
Special Conditions
APPRO
IL Inspector pa e