HomeMy WebLinkAboutDrain Layers Permit 164 Morgan Farms Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at (r�� 3. � : /
at premises owned by _ ' .k= 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.
SPECIAL CONDITIONS
Desired Starting Date - 2 Estimated Time for Completion 2 (=_ tc-S
Permit to be issued to
the holder of Drain Layer's License No. -2:li-7-7 ICI . 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 s rdi \thereof. Applicant hats received
Town Permit No. and/or CHD Permit No.
Signed -
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 the name of the Town of South Windsor:
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Engineefing Department Sate
Connection Charge Paid %%<�'C. - Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started /l �8 Date completed
Sufficient notif icatiori received: r/Yes No '
Special Conditions
APPROVED:
Inspec r Dat e