HomeMy WebLinkAboutDrain Layers Permit 171 Morgan Farms Roa TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1�No. 4 8 U 4
I'1 I m or'Ja� V_WV( Q �?1t
Pursuant to written application, permission is he eby granted to the Licensod Drain Layer
named herein to perform�t w k i�# cst:ed below a �' f �`
at premises owned by whose address 1is
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 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Zd 7 7y9 . Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer he eby agrees to all the terms and
conditions set forth in the permit and the reverse sjde)thereof. Applicant h rec ived
Town Permit No. and/or CHD Permit No.
01
Signed /
Licensed% rain Layer
; j
The above named Drain Layer has a valid lice6de issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy thppe nam of the To of South Windsor:
--v 70
7_Z
Engineering Depart nt Date
Connection Charge Paid �l/ J
$ % y I Permit Fee: Paid $
r ,
Check Number '
�Ce Issued by
Tax Office
ii
INSPECTION Q,
Date work started - Date completed /
Sufficient notification recei ed: _� Yes No
Special Conditions
AP ROVED:
ns ctor pate