HomeMy WebLinkAboutDrain Layers Permit 41 Morgan Farms Road rr
TOWN OF SOUTH WI N DSOR
r DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q, 4446
L A 1
Pursuant to written application, permission is bpreby gra ted to the Licensed D ain Layer
named herein to. perfo he. wor 'n 'cated_below at
at premises owned by 51 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 SEWACE ( ), 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. a2p6 y 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 thereo�: Applicant has received-
Town Permit No. and/or CHD Permit No.
i
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 'n the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 1 "`j 0 Permit Fee: Paid $
Check Number '
Issued by
Tax affice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date