HomeMy WebLinkAboutDrain Layers Permit 590 Miller Road SN •
r TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
► BUREAU OF POLLUTION CONTROL �+
DRAIN LAYER'S PERMIT b. 4690
19`
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at <<
at premises owned by tl `
.16 whose address is
1) ., 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.
ow
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 Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. A plican ha received
Town Permit No. and/or CHD Permit No. 093 -Al
Signed;.. `
Lic nsed 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 ✓_`j j%1.O(j Permit Fee: Paid $ /,j,06
Check Number
Issued by
Tax Uffice
INSPECTION
Date work started Date completed
Sufficient notifitl,'�`tion received: Yes No
Special ConditfMi-
APPROVED:
Inspector pate